By Jon E. Zibbell , Arnie Aldridge, Megan Grabenauer , David Heller , Sarah Duhart Clarke, , DeMia Pressley, Hope Smiley McDonald

Summary Background The overdose epidemic in the United States (US) continues to generate unprecedented levels of mortality. There is urgent need for a national data system capable of yielding high-quality, timely, and actionable information on existing and emerging drugs. Public health researchers have started using law enforcement forensic laboratory data to obtain surveillance information on illicit drugs. This study is the first to use drug reports from the entire US to examine correlations between a changing drug supply and increasing opioid-involved overdose deaths (OOD) on a national scale. Methods This study is observational and investigates associations between law enforcement drug reports and OOD for the US from 2014 to 2019. OOD data are from the Centers for Disease Control and Prevention’s National Vital Statistics System restricted-use multiple cause of death files. The US Drug Enforcement Administration’s National Forensic Laboratory Information System (NFLIS) contains forensic laboratory–tested drug exhibit information for the entire US (NFLIS-Drug). Counts of forensic laboratory reports and OOD were aggregated for each state by month, quarter, and year. A two-way fixed effects model was used to estimate contemporaneous and lagged associations. Findings Between 2014 and 2019 in the US, 249,522 OOD were reported, with the annual number nearly doubling from 28,723 to 50,179. OOD involving illicitly manufactured fentanyls (IMF) also increased substantially during this period, from 19.4% to 72.9%. In addition, 3,817,438 forensic laboratory reports in the US that were reported to NFLIS-Drug contained an opioid, stimulant, or benzodiazepine. Reports of fentanyl and fentanyl-related compounds (FFRC) had the strongest association with OOD. Each additional FFRC exhibit was associated with a 2.97% (95% CI: 1.7%, 4.1%) increase in OOD per 100,000 persons per quarter. Interpretation Adding to the emerging consensus, protracted growth in IMF supply was more strongly associated with OOD than all other illicit drugs reported to NFLIS-Drug over the study time period. Findings demonstrate NFLIS-Drug data usefulness for research that require proxy indicators for the illicit drugs supply. A concerted effort between public health and public safety to make NFLIS-Drug more timely could strengthen its utility as a national, public health, drug surveillance system.

The Lancet Regional Health - Americas. Volume 25, September 2023, 100569

By Joel Wallman, Richard Rosenfeld, Randolph Roth

The twenty-five-year epidemic of opioid misuse in the United States has taken at least 750,000 lives through overdose. We undertook to learn whether this toll might have been accompanied by an increase in violence resulting from growth in the illicit opioid market, which, like most illicit drug markets, includes a risk of violence due to conflicts among sellers and between sellers and buyers. We found that increases in activity in this market were associated with—and arguably caused—increased levels of homicide. Using county opioid overdose rates as a measure of levels of transactions in the illicit market, we looked for an association between those rates and county homicide rates between 1999 and 2015. …Despite this growth in overdose rates during the period, homicide rates declined for both groups and in both Appalachian and non-Appalachian counties. … The finding of another harm wrought by the opioid epidemic provides another reason to pursue vigorous public-health efforts, with a strong emphasis on treatment, to stem the epidemic.   

New York:  The Harry Frank Guggenheim Foundation, 2023. 20p.