Last data update: Nov 04, 2024. (Total: 48056 publications since 2009)
Records 1-14 (of 14 Records) |
Query Trace: Kariisa M[original query] |
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Illicitly manufactured fentanyl-involved overdose deaths with detected xylazine - United States, January 2019-June 2022
Kariisa M , O'Donnell J , Kumar S , Mattson CL , Goldberger BA . MMWR Morb Mortal Wkly Rep 2023 72 (26) 721-727 In 2022, provisional data indicated that more than two thirds (68%) of the reported 107,081 drug overdose deaths in the United States involved synthetic opioids other than methadone, principally illicitly manufactured fentanyls (IMFs) (1). Xylazine, a nonopioid sedative not approved for human use and with no known antidote, has been increasingly detected in IMF products in the U.S. drug supply* and in IMF-involved overdose deaths (2). Limited studies suggest xylazine can cause central nervous system depression, respiratory depression, bradycardia, and hypotension in humans (3,4); chronic use might lead to severe withdrawal symptoms(†) as well as skin ulcerations (4). This report uses data from CDC's State Unintentional Drug Overdose Reporting System (SUDORS) to describe IMF-involved(§) overdose deaths with and without xylazine detected that occurred during January 2019-June 2022. Among 21 jurisdictions, which included 20 states and the District of Columbia, the monthly percentage of IMF-involved deaths with xylazine detected increased 276%, from 2.9% to 10.9%. Among IMF-involved deaths during January 2021-June 2022 in 32 jurisdictions, xylazine was detected in a higher percentage of jurisdictions in the Northeast U.S. Census Bureau region; listing detected xylazine as a cause of death varied across jurisdictions. Expanded postmortem and illicit drug product testing for xylazine is needed to clarify prevalence in drug supplies; further investigation of xylazine's effects on humans is necessary to characterize morbidity and overdose risk. It is important for overdose prevention and response messages to highlight the potential presence of xylazine in IMF products and emphasize the need for respiratory and cardiovascular support to address the sedative effects of xylazine. |
Vital signs: Drug overdose deaths, by selected sociodemographic and social determinants of health characteristics - 25 states and the District Of Columbia, 2019-2020
Kariisa M , Davis NL , Kumar S , Seth P , Mattson CL , Chowdhury F , Jones CM . MMWR Morb Mortal Wkly Rep 2022 71 (29) 940-947 INTRODUCTION: Drug overdose deaths increased approximately 30% from 2019 to 2020 in the United States. Examining rates by demographic and social determinants of health characteristics can identify disproportionately affected populations and inform strategies to reduce drug overdose deaths. METHODS: Data from the State Unintentional Drug Overdose Reporting System (SUDORS) were used to analyze overdose death rates from 2019 to 2020 in 25 states and the District of Columbia. Rates were examined by race and ethnicity and county-level social determinants of health (e.g., income inequality and treatment provider availability). RESULTS: From 2019 to 2020, drug overdose death rates increased by 44% and 39% among non-Hispanic Black (Black) and non-Hispanic American Indian or Alaska Native (AI/AN) persons, respectively. Significant disparities were found across sex, age, and racial and ethnic subgroups. In particular, the rate in 2020 among Black males aged ≥65 years (52.6 per 100,000) was nearly seven times that of non-Hispanic White males aged ≥65 years (7.7). A history of substance use was frequently reported. Evidence of previous substance use treatment was lowest for Black persons (8.3%). Disparities in overdose deaths, particularly among Black persons, were larger in counties with greater income inequality. Opioid overdose rates in 2020 were higher in areas with more opioid treatment program availability compared with areas with lower opioid treatment availability, particularly among Black (34.3 versus 16.6) and AI/AN (33.4 versus 16.2) persons. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Health disparities in overdose rates continue to worsen, particularly among Black and AI/AN persons; social determinants of health, such as income inequality, exacerbate these inequities. Implementation of available, evidence-based, culturally responsive overdose prevention and response efforts that address health disparities impacting disproportionately affected populations are urgently needed. |
Increases in disparities in US drug overdose deaths by race and ethnicity: Opportunities for clinicians and health systems
Kariisa M , Seth P , Jones CM . JAMA 2022 328 (5) 421-422 For more than a decade, drug overdose deaths have been the leading cause of injury death in the US. During the COVID-19 pandemic and its related stressors and disruptions in access to care, the number of overdose deaths increased substantially and are predicted to account for more than 107 000 deaths in the US in 2021.1 The unprecedented increase in overdose deaths has been fueled by the continued proliferation of highly lethal synthetic opioids, such as illicitly manufactured fentanyl and fentanyl analogues, and a resurgence of stimulants, particularly methamphetamine, into the illicit drug supply.2 Importantly, as overdose deaths have increased, the demographic profile of those dying has shifted and disproportionately affects certain racial and ethnic minority populations.3 A multisectoral approach that includes structural and policy-level changes and clinician- and health-system–based approaches, with an intentional focus on racial and ethnic disparities and the long-standing inequities that contribute to increased risk for overdose, is essential to respond to this urgent public health crisis. |
Using death scene and toxicology evidence to define involvement of heroin, pharmaceutical morphine, illicitly manufactured fentanyl, and pharmaceutical fentanyl in opioid overdose deaths, 38 states and the District of Columbia, January 2018-December 2019
O'Donnell J , Gladden RM , Kariisa M , Mattson CL . Addiction 2021 117 (5) 1483-1490 BACKGROUND AND AIMS: Tracking specific drugs contributing to drug overdose deaths is limited when relying on death certificate (DC) data alone. This study aimed to determine whether integrating DC data with medical examiner/coroner reports, including postmortem toxicology and death investigation findings, would enhance identification of 1) heroin and pharmaceutical morphine involvement in overdose deaths and 2) fentanyl source (illicitly manufactured vs. pharmaceutical). DESIGN: Retrospective analysis of heroin, pharmaceutical morphine, illicitly manufactured fentanyl (IMF), and pharmaceutical fentanyl involvement in fatal overdoses. DC and toxicology data were compared with enhanced definitions integrating overdose scene, witness, and toxicology evidence. SETTING: United States: 38 states and the District of Columbia, participating in Centers for Disease Control and Prevention (CDC)-funded opioid overdose death surveillance. CASES: Opioid overdose decedents from funded jurisdictions; deaths during January 1, 2018-December 31, 2019. MEASUREMENTS: Using medical examiner/coroner report data, deaths with 6-acetylmorphine and/or morphine detected by postmortem toxicology were defined as confirmed, probable, or suspected heroin deaths, or probable pharmaceutical morphine deaths. Fentanyl was defined as probable or suspected IMF or probable pharmaceutical fentanyl. FINDINGS: The enhanced definition defined 18,393 deaths as confirmed, probable, or suspected heroin deaths (including 2,678 with morphine listed as cause of death on the DC), and 404 as probable pharmaceutical morphine deaths. Among deaths with fentanyl detected, 89.3% were defined as probable or suspected IMF and 1.0% as probable pharmaceutical fentanyl. Fentanyl source could not be determined for 9.7% of deaths. CONCLUSIONS: Integrating drug overdose scene, witness, and toxicology findings can improve identification of specific drugs contributing to overdose deaths and enhance overdose intervention targeting. |
Notes from the field: Xylazine detection and involvement in drug overdose deaths - United States, 2019
Kariisa M , Patel P , Smith H , Bitting J . MMWR Morb Mortal Wkly Rep 2021 70 (37) 1300-1302 Xylazine is a drug used in veterinary medicine as an animal sedative with muscle relaxant and analgesic properties (1). It is not approved by the Food and Drug Administration for use in humans, in whom it acts as a central nervous system depressant and can cause respiratory depression, slowed heart rate, and hypotension (2). When used as a toxic adulterant in illicitly produced opioids such as fentanyl or heroin (3), xylazine might potentiate sedation and respiratory depression, increasing the risk for fatal overdose. In addition, because xylazine is not an opioid, it does not respond to opioid reversal agents such as naloxone; therefore, if illicit opioid products containing xylazine are used, naloxone might be less effective in fully reversing an overdose. Several states have reported increases in xylazine-involved overdose deaths; however, the prevalence of xylazine involvement in drug overdose deaths (overdose deaths) has not been extensively studied, particularly in the United States (4). To better understand the impact of xylazine adulteration on the evolving drug overdose epidemic in the United States, CDC analyzed unintentional and undetermined intent overdose death data from the State Unintentional Drug Overdose Reporting System (SUDORS) in 38 states and the District of Columbia (DC).*,† |
Drug overdose deaths involving cocaine and psychostimulants with abuse potential among racial and ethnic groups - United States, 2004-2019
Kariisa M , Seth P , Scholl L , Wilson N , Davis NL . Drug Alcohol Depend 2021 227 109001 BACKGROUND: Drug overdose deaths involving stimulants, including cocaine and psychostimulants with abuse potential (e.g., methamphetamine), have been increasing, partly because of co-involvement with opioids. Stimulant-involved overdose deaths have disproportionately increased among non-Hispanic Black (Black) and non-Hispanic American Indian/Alaskan Native (AI/AN) persons; however, the role of opioids in exacerbating disproportionate stimulant-involved death rates is unclear. METHODS: Analysis of National Vital Statistics System multiple cause-of-death mortality files examined age-adjusted cocaine- and psychostimulant-involved death rates. Analyses of death rates stratified by racial and ethnic group and opioid co-involvement included: 1) Joinpoint regression of 2004-2019 trends, 2) changes in rates from 2018 to 2019, and 3) demographic and geographic characteristics of 2019 deaths. RESULTS: From 2004 to 2019, cocaine and psychostimulant-involved death rates were higher for Black and AI/AN persons, respectively. Among all groups, increases in cocaine-involved overdose rates were largely driven by opioid co-involvement, particularly after 2013. From 2004 to 2019, rates for psychostimulant-involved deaths increased with and without opioid co-involvement. Rates for overdoses co-involving cocaine and synthetic opioids increased from 2018 to 2019 for Hispanic, non-Hispanic White (White), and Black persons. Psychostimulant-involved overdose rates with and without synthetic opioid co-involvement increased among Hispanic, White, and Black persons. In 2019, Black and AI/AN persons continued to experience higher cocaine- and psychostimulant-involved death rates, respectively. CONCLUSIONS: Stimulant-involved deaths continue to increase, and the role of opioids in driving these deaths varies by race and ethnicity. Ensuring equitable access to proven prevention and treatment interventions and incorporating social determinants of health into future research around effective pharmacotherapies may help reduce stimulant-involved overdose deaths. |
Trends and geographic patterns in drug and synthetic opioid overdose deaths - United States, 2013-2019
Mattson CL , Tanz LJ , Quinn K , Kariisa M , Patel P , Davis NL . MMWR Morb Mortal Wkly Rep 2021 70 (6) 202-207 Deaths involving synthetic opioids other than methadone (synthetic opioids), which largely consist of illicitly manufactured fentanyl; psychostimulants with abuse potential (e.g., methamphetamine); and cocaine have increased in recent years, particularly since 2013 (1,2). In 2019, a total of 70,630 drug overdose deaths occurred, corresponding to an age-adjusted rate of 21.6 per 100,000 population and a 4.3% increase from the 2018 rate (20.7) (3). CDC analyzed trends in age-adjusted overdose death rates involving synthetic opioids, psychostimulants, cocaine, heroin, and prescription opioids during 2013-2019, as well as geographic patterns in synthetic opioid- and psychostimulant-involved deaths during 2018-2019. From 2013 to 2019, the synthetic opioid-involved death rate increased 1,040%, from 1.0 to 11.4 per 100,000 age-adjusted (3,105 to 36,359). The psychostimulant-involved death rate increased 317%, from 1.2 (3,627) in 2013 to 5.0 (16,167) in 2019. In the presence of synthetic opioid coinvolvement, death rates for prescription opioids, heroin, psychostimulants, and cocaine increased. In the absence of synthetic opioid coinvolvement, death rates increased only for psychostimulants and cocaine. From 2018 to 2019, the largest relative increase in the synthetic opioid-involved death rate occurred in the West (67.9%), and the largest relative increase in the psychostimulant-involved death rate occurred in the Northeast (43.8%); these increases represent important changes in the geographic distribution of drug overdose deaths. Evidence-based prevention and response strategies including substance use disorder treatment and overdose prevention and response efforts focused on polysubstance use must be adapted to address the evolving drug overdose epidemic. |
Drug and opioid-involved overdose deaths - United States, 2017-2018
Wilson N , Kariisa M , Seth P , Smith H4th , Davis NL . MMWR Morb Mortal Wkly Rep 2020 69 (11) 290-297 Of the 70,237 drug overdose deaths in the United States in 2017, approximately two thirds (47,600) involved an opioid (1). In recent years, increases in opioid-involved overdose deaths have been driven primarily by deaths involving synthetic opioids other than methadone (hereafter referred to as synthetic opioids) (1). CDC analyzed changes in age-adjusted death rates from 2017 to 2018 involving all opioids and opioid subcategories* by demographic characteristics, county urbanization levels, U.S. Census region, and state. During 2018, a total of 67,367 drug overdose deaths occurred in the United States, a 4.1% decline from 2017; 46,802 (69.5%) involved an opioid (2). From 2017 to 2018, deaths involving all opioids, prescription opioids, and heroin decreased 2%, 13.5%, and 4.1%, respectively. However, deaths involving synthetic opioids increased 10%, likely driven by illicitly manufactured fentanyl (IMF), including fentanyl analogs (1,3). Efforts related to all opioids, particularly deaths involving synthetic opioids, should be strengthened to sustain and accelerate declines in opioid-involved deaths. Comprehensive surveillance and prevention measures are critical to reducing opioid-involved deaths, including continued surveillance of evolving drug use and overdose, polysubstance use, and the changing illicit drug market; naloxone distribution and outreach to groups at risk for IMF exposure; linkage to evidence-based treatment for persons with substance use disorders; and continued partnerships with public safety. |
Notes from the field: Opioid-involved overdose deaths with fentanyl or fentanyl analogs detected - 28 states and the District of Columbia, July 2016-December 2018
O'Donnell J , Gladden RM , Goldberger BA , Mattson CL , Kariisa M . MMWR Morb Mortal Wkly Rep 2020 69 (10) 271-273 Approximately two thirds of the 70,237 U.S. drug overdose deaths reported in 2017 involved opioids (1). Since 2013, opioid-involved overdose deaths involving illicitly manufactured fentanyl has sharply increased (1,2). Fentanyl analogs are structurally similar to fentanyl but vary in potency, are primarily illicitly distributed, and require specific postmortem toxicology testing for detection.* Deaths involving fentanyl analogs, particularly carfentanil, increased in 10 states during 2016–2017 and often co-occurred with fentanyl (3). CDC funded 32 states and the District of Columbia (DC) to enhance postmortem toxicology testing and abstract data from death certificates and medical examiner and coroner reports on opioid-involved overdose deaths of unintentional and undetermined intent through the State Unintentional Drug Overdose Reporting System (SUDORS).† Twelve states have collected data since July 2016, and an additional 20 states and DC began collecting data in July 2017 as part of a rapid expansion of SUDORS. This analysis 1) reports rapid changes in opioid-involved overdose deaths with fentanyl§ and fentanyl analogs detected during July 2016–December 2018 among 10 states with available SUDORS data¶ and 2) provides a description of the most recent data on deaths with fentanyl and fentanyl analogs detected among 28 states and DC.** Tracking specific drugs involved in overdose deaths is critical because the risk for overdose for fentanyl and fentanyl analogs varies substantially. There are considerable differences in potency, dose, purity, and co-use patterns among drug products.†† |
Drug overdose deaths involving cocaine and psychostimulants with abuse potential - United States, 2003-2017
Kariisa M , Scholl L , Wilson N , Seth P , Hoots B . MMWR Morb Mortal Wkly Rep 2019 68 (17) 388-395 In 2016, a total of 63,632 persons died from drug overdoses in the United States (1). Drug overdose deaths involving cocaine, psychostimulants with abuse potential (psychostimulants), or both substances combined increased 42.4% from 12,122 in 2015 to 17,258 in 2016.* Psychostimulants with abuse potential include drugs such as methamphetamine, 3,4-methylenedioxy-methamphetamine (MDMA), dextroamphetamine, levoamphetamine, methylphenidate (Ritalin), and caffeine. From 2015 to 2016, cocaine-involved and psychostimulant-involved death rates increased 52.4% and 33.3%, respectively (1). A total of 70,237 persons died from drug overdoses in the United States in 2017; approximately two thirds of these deaths involved an opioid (2). CDC analyzed 2016-2017 changes in age-adjusted death rates involving cocaine and psychostimulants by demographic characteristics, urbanization levels, U.S. Census region, 34 states, and the District of Columbia (DC). CDC also examined trends in age-adjusted cocaine-involved and psychostimulant-involved death rates from 2003 to 2017 overall, as well as with and without co-involvement of opioids. Among all 2017 drug overdose deaths, 13,942 (19.8%) involved cocaine, and 10,333 (14.7%) involved psychostimulants. Death rates increased from 2016 to 2017 for both drug categories across demographic characteristics, urbanization levels, Census regions, and states. In 2017, opioids were involved in 72.7% and 50.4% of cocaine-involved and psychostimulant-involved overdoses, respectively, and the data suggest that increases in cocaine-involved overdose deaths from 2012 to 2017 were driven primarily by synthetic opioids. Conversely, increases in psychostimulant-involved deaths from 2010 to 2017 occurred largely independent of opioids, with increased co-involvement of synthetic opioids in recent years. Provisional data from 2018 indicate that deaths involving cocaine and psychostimulants are continuing to increase.(dagger) Increases in stimulant-involved deaths are part of a growing polysubstance landscape. Increased surveillance and evidence-based multisectoral prevention and response strategies are needed to address deaths involving cocaine and psychostimulants and opioids. Enhancing linkage to care, building state and local capacity, and public health/public safety collaborations are critical components of prevention efforts. |
Drug and opioid-involved overdose deaths - United States, 2013-2017
Scholl L , Seth P , Kariisa M , Wilson N , Baldwin G . MMWR Morb Mortal Wkly Rep 2018 67 (5152) 1419-1427 The 63,632 drug overdose deaths in the United States in 2016 represented a 21.4% increase from 2015; two thirds of these deaths involved an opioid (1). From 2015 to 2016, drug overdose deaths increased in all drug categories examined; the largest increase occurred among deaths involving synthetic opioids other than methadone (synthetic opioids), which includes illicitly manufactured fentanyl (IMF) (1). Since 2013, driven largely by IMF, including fentanyl analogs (2-4), the current wave of the opioid overdose epidemic has been marked by increases in deaths involving synthetic opioids. IMF has contributed to increases in overdose deaths, with geographic differences reported (1). CDC examined state-level changes in death rates involving all drug overdoses in 50 states and the District of Columbia (DC) and those involving synthetic opioids in 20 states, during 2013-2017. In addition, changes in death rates from 2016 to 2017 involving all opioids and opioid subcategories,* were examined by demographics, county urbanization levels, and by 34 states and DC. Among 70,237 drug overdose deaths in 2017, 47,600 (67.8%) involved an opioid.(dagger) From 2013 to 2017, drug overdose death rates increased in 35 of 50 states and DC, and significant increases in death rates involving synthetic opioids occurred in 15 of 20 states, likely driven by IMF (2,3). From 2016 to 2017, overdose deaths involving all opioids and synthetic opioids increased, but deaths involving prescription opioids and heroin remained stable. The opioid overdose epidemic continues to worsen and evolve because of the continuing increase in deaths involving synthetic opioids. Provisional data from 2018 indicate potential improvements in some drug overdose indicators;( section sign) however, analysis of final data from 2018 is necessary for confirmation. More timely and comprehensive surveillance data are essential to inform efforts to prevent and respond to opioid overdoses; intensified prevention and response measures are urgently needed to curb deaths involving prescription and illicit opioids, specifically IMF. |
Opportunities to prevent overdose deaths involving prescription and illicit opioids, 11 states, July 2016-June 2017
Mattson CL , O'Donnell J , Kariisa M , Seth P , Scholl L , Gladden RM . MMWR Morb Mortal Wkly Rep 2018 67 (34) 945-951 In 2016, 63,632 drug overdose deaths occurred in the United States, 42,249 (66.4%) of which involved opioids (1). The development of prevention programs are hampered by a lack of timely data on specific substances contributing to and circumstances associated with fatal overdoses. This report describes opioid overdose deaths (referred to as opioid deaths) for decedents testing positive for prescription opioids (e.g., oxycodone and hydrocodone), illicit opioids (e.g., heroin, illicitly manufactured fentanyl, and fentanyl analogs), or both prescription and illicit opioids, and describes circumstances surrounding the overdoses, in 11 states participating in CDC's Enhanced State Opioid Overdose Surveillance (ESOOS) program.* During July 2016-June 2017, among 11,884 opioid overdose deaths, 17.4% of decedents tested positive for prescription opioids only, 58.7% for illicit opioids only, and 18.5% for both prescription and illicit opioids (type of opioid could not be classified in 649 [5.5%] deaths). Approximately one in 10 decedents had been released from an institutional setting in the month preceding the fatal overdose. Bystanders were reportedly present in approximately 40% of deaths; however, naloxone was rarely administered by a layperson. Enhanced surveillance data from 11 states provided more complete information on the substances involved in and circumstances surrounding opioid overdose deaths. Consistent with other emerging evidence and recommendations,(dagger) these data suggest prevention efforts should prioritize naloxone distribution to persons misusing opioids or using high dosage prescription opioids and to their family members and friends. In addition, these data suggest a need to expand treatment and support for persons who have experienced a nonfatal overdose and to expand treatment in detention facilities and upon release. |
Notes from the field: Overdose deaths with carfentanil and other fentanyl analogs detected - 10 states, July 2016-June 2017
O'Donnell J , Gladden RM , Mattson CL , Kariisa M . MMWR Morb Mortal Wkly Rep 2018 67 (27) 767-768 Fentanyl and fentanyl analogs are increasingly involved in opioid overdose deaths, and new fentanyl analogs continue to be identified (1). Carfentanil, the most potent fentanyl analog detected in the United States, is intended for sedation of large animals and is estimated to have 10,000 times the potency of morphine (2). It has recently been reported in an alarming number of deaths in some states. Ohio reported nearly 400 carfentanil-involved deaths during July–December 2016, and Florida reported >500 such deaths for all of 2016 (3,4). |
Increases in heroin overdose deaths - 28 states, 2010 to 2012
Rudd RA , Paulozzi LJ , Bauer MJ , Burleson RW , Carlson RE , Dao D , Davis JW , Dudek J , Eichler BA , Fernandes JC , Fondario A , Gabella B , Hume B , Huntamer T , Kariisa M , Largo TW , Miles J , Newmyer A , Nitcheva D , Perez BE , Proescholdbell SK , Sabel JC , Skiba J , Slavova S , Stone K , Tharp JM , Wendling T , Wright D , Zehner AM . MMWR Morb Mortal Wkly Rep 2014 63 (39) 849-854 Nationally, death rates from prescription opioid pain reliever (OPR) overdoses quadrupled during 1999-2010, whereas rates from heroin overdoses increased by <50%. Individual states and cities have reported substantial increases in deaths from heroin overdose since 2010. CDC analyzed recent mortality data from 28 states to determine the scope of the heroin overdose death increase and to determine whether increases were associated with changes in OPR overdose death rates since 2010. This report summarizes the results of that analysis, which found that, from 2010 to 2012, the death rate from heroin overdose for the 28 states increased from 1.0 to 2.1 per 100,000, whereas the death rate from OPR overdose declined from 6.0 per 100,000 in 2010 to 5.6 per 100,000 in 2012. Heroin overdose death rates increased significantly for both sexes, all age groups, all census regions, and all racial/ethnic groups other than American Indians/Alaska Natives. OPR overdose mortality declined significantly among males, persons aged <45 years, persons in the South, and non-Hispanic whites. Five states had increases in the OPR death rate, seven states had decreases, and 16 states had no change. Of the 18 states with statistically reliable heroin overdose death rates (i.e., rates based on at least 20 deaths), 15 states reported increases. Decreases in OPR death rates were not associated with increases in heroin death rates. The findings indicate a need for intensified prevention efforts aimed at reducing overdose deaths from all types of opioids while recognizing the demographic differences between the heroin and OPR-using populations. Efforts to prevent expansion of the number of OPR users who might use heroin when it is available should continue. |
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- Page last updated:Nov 04, 2024
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