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Elevated drug overdose mortality among Americans who visit Florida, 2003–2020
  1. Ilan Shrira1,
  2. Joshua D Foster2
  1. 1Department of Psychology, Pennsylvania State University, University Park, Pennsylvania, USA
  2. 2Department of Psychology, University of South Alabama, Mobile, Alabama, USA
  1. Correspondence to Dr Ilan Shrira, Department of Psychology, Pennsylvania State University, University Park, Pennsylvania, USA; ijs5210{at}psu.edu

Abstract

Objective Florida state has played a conspicuous role in the current U.S. drug epidemic. Reports suggest that even non-Florida residents may suffer excessive overdose fatalities while visiting the state, possibly in connection to two sets of events: (1) the overprescribing of controlled substances, and more recently, (2) the exploitation of patients’ insurance benefits by unscrupulous operators of substance use treatment facilities in Florida. To date, however, no research has examined the overdose fatalities of non-Florida residents inside Florida.

Methods Death certificate data were used to calculate proportionate mortality ratios for overdoses among Florida residents and visitors. Deaths occurring in the rest of the USA were used as reference populations.

Results Between 2003 and 2020, overdose mortality was slightly elevated for Florida residents within their home counties (106.7 (95% CI 105.8 to 107.5)) and in other Florida counties (113.0 (95% CI 110.0 to 116.0)). Significantly, this mortality was much higher among out-of-state visitors in Florida (163.1 (95% CI 157.5 to 168.8)). When analysed by year, greater overdose mortality among visitors coincided with years when drug prescribing in Florida was rampant, and with the advent of expanded insurance coverage for substance use treatment. During this more recent period (since 2014), overdose mortality was exceptionally high for out-of-state visitors in Palm Beach County, where reports of malpractice in the Florida treatment industry have been concentrated.

Conclusions Overdose mortality was disproportionately high among out-of-state visitors in Florida. The results suggest that the regulatory policies in Florida may be implicated in drug-related casualties of people who live in other parts of the USA.

  • Poisoning
  • Mortality
  • Drugs

Data availability statement

Data may be obtained from a third party and are not publicly available. Much of the data reported for this study were based on publicly-available datasets that can be downloaded at http://www.cdc.gov/nchs/data_access/vitalstatsonline.htm. Some of the data used for this research are not publicly available due to privacy restrictions. These data were provided in restricted-use files with special permission from the National Center for Health Statistics, Division of Vital Statistics, and were granted under the terms of a data-use agreement for this study.

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Data availability statement

Data may be obtained from a third party and are not publicly available. Much of the data reported for this study were based on publicly-available datasets that can be downloaded at http://www.cdc.gov/nchs/data_access/vitalstatsonline.htm. Some of the data used for this research are not publicly available due to privacy restrictions. These data were provided in restricted-use files with special permission from the National Center for Health Statistics, Division of Vital Statistics, and were granted under the terms of a data-use agreement for this study.

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Footnotes

  • Contributors IS conceived of the study concept, acquired the data, carried out the data analyses, drafted the initial manuscript, revised the manuscript, and prepared the manuscript for submission. JF contributed to the design of the study, interpreted the data, wrote portions of the manuscript, and provided critical revisions of the manuscript. IS serves as the guarantor, and accepts full responsibility for the finished work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.