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Evidence of Pre-mortem Opioid Use among Fentanyl Overdose Decedents in a Safety Net Healthcare System

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Abstract

The rapid increase in fentanyl overdose deaths, particularly those also attributed to stimulants, has led to concerns about unintentional fentanyl exposure. Utilizing vital and medical record data, we identified overdose decedents from 2018 to 2021 in San Francisco who received care in the safety net system in the 3 years preceding death. Among 506 decedents, medical record evidence of pre-mortem opioid use was present for 48% of stimulant-only, 56% of stimulant-fentanyl, 65% of fentanyl-only, and 82% of non-fentanyl opioid decedents (p<0.001). Among stimulant-fentanyl decedents, an increase in 10 years of age (adjusted odds ratio (aOR) 0.74 [95% CI:0.59–0.94]) and race other than White or Black (aOR 0.36 [95% CI:0.15–0.87]) had lower odds of evidence of pre-mortem opioid use. While not conclusive, these findings raise the possibility that a significant proportion of fentanyl overdose decedents in San Francisco may have not intended to consume an opioid on the occasion of their death.

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Acknowledgements

This project was supported by NIDA grant K24DA042720 and CDC grant R01CE003364.

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Authors and Affiliations

  1. San Francisco Department of Public Health, 25 Van Ness Avenue, Ste. 500, San Francisco, CA, 94102, USA

    Phillip O. Coffin & Vanessa M. McMahan

  2. University of California San Francisco, 500 Parnassus Ave, San Francisco, CA, 94143, USA

    Phillip O. Coffin & Ciaran Murphy

Authors
  1. Phillip O. Coffin
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  2. Vanessa M. McMahan
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  3. Ciaran Murphy
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Correspondence to Phillip O. Coffin.

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Appendix

Appendix

Table 2 Characteristics of stimulant and opioid decedents in and out of safety net care
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Table 3 Demographic characteristics, evidence of pre-mortem opioid use, and involvement of a benzodiazepine in death among deaths that only involved a stimulant (n=140)
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Table 4 Demographic characteristics, evidence of pre-mortem opioid use, and involvement of a benzodiazepine in death among deaths that only involved a stimulant and fentanyl (n=220)
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Table 5 Demographic characteristics, evidence of pre-mortem opioid use, and involvement of a benzodiazepine in death among deaths that only involved another opioid (not fentanyl) (n=112)
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Table 6 Proportion of decedents with evidence of pre-mortem opioid use by substances involved in death and demographics (n=506)
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Table 7 Results of multivariable logistic regression analysis of demographic characteristics associated with evidence of opioid use in 3 years preceding death among stimulant-fentanyl decedents (n=220)
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Table 8 Results of multivariable logistic regression analysis of demographic characteristics associated with evidence of clinical history of opioid use in 3 years preceding death among fentanyl deaths (n=254)
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Coffin, P.O., McMahan, V.M. & Murphy, C. Evidence of Pre-mortem Opioid Use among Fentanyl Overdose Decedents in a Safety Net Healthcare System. J Urban Health 99, 865–872 (2022). https://doi.org/10.1007/s11524-022-00663-1

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  • DOI: https://doi.org/10.1007/s11524-022-00663-1

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