ArticleThe International journal on drug policy2025
Leveraging pooled medical examiner records to surveil complex and emerging patterns of polysubstance use in the United States.
Article in The International journal on drug policy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed.
- Implementation of contingency management with women engaging in polysubstance use.Addiction science & clinical practice · 2025Trial
- Determination of mitragynine concentrations in medicolegal death investigations at the Oklahoma Office of the Chief Medical Examiner from 2022 to 2023.Journal of forensic sciences · 2026Article
- Recognising intoxication in healthcare: evidence, challenges, and implications.Addiction science & clinical practice · 2026Review
- Improving drug identification in overdose death surveillance by using clinical natural language processing models.Journal of forensic sciences · 2026Article
- What does 'polysubstance' really mean? Comparing drug-involved deaths in CDC records vs. detailed medical examiner data from Los Angeles.The International journal on drug policy · 2026Article
- Article
- Enhancing substance use detection in clinical notes with large language models.Drug and alcohol dependence · 2025Article
- What Does 'Polysubstance' Really Mean? Comparing Drug-Involved Deaths in Los Angeles in CDC Records vs. Detailed Medical Examiner Data.medRxiv : the preprint server for health sciences · 2025Article
- Introduction to the special section on polysubstance use: Emerging trends, psychosocial drivers, and treatment challenges.The International journal on drug policy · 2025Article
- Enhancing Substance Use Detection in Clinical Notes with Large Language Models.Research square · 2025Article
- Polysubstance Use Is Not Synonymous With Poly Substance Use Disorder.American journal of public health · 2025Article
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
backgroundThe United States (US) is an extreme global outlier for drug-related death rates. However, data describing drug-related deaths are generally available only on an 8-13-month lag. Furthermore, granular details about substance-involvement are often not available, which particularly stymies efforts to track fatal polysubstance and novel psychoactive substance use. Detailed medical examiner records provide a powerful source of information for drug-related death surveillance, but have been underutilized.
methodsWe pooled medical examiner data from five US states and 14 counties that together comprise 18% of the US population to examine demographic, geographic, and drug-specific trends in polysubstance drug-related deaths. We employed mixed effects logistic regression to identify demographic factors associated with polysubstance rather than single substance drug-related deaths. We assessed the correlations between drug classes and described geographic variation in the prevalence of specific drugs and the presence of novel and emerging psychoactive substances.
resultsOur sample included 73,077 drug-related deaths from 2012 through early 2022. Nearly two-thirds of drug-related deaths were polysubstance-involved, with the number and percentage growing annually. High percentages of polysubstance drug-related deaths were observed in both urban and rural jurisdictions. After adjusting for year and jurisdiction, female, American Indian and Alaska Native, and White individuals had the most elevated odds of polysubstance drug-related deaths. Drug-related deaths involving benzodiazepines or opioids, whether pharmaceutical or illicit, and other pharmaceutical drugs were most likely to have polysubstance involvement, while methamphetamine-involved deaths were least likely to involve multiple substances. Strong correlations were observed between prescription opioids and prescription benzodiazepines, fentanyl and xylazine, and designer benzodiazepines and novel synthetic opioids.
conclusionsAnalysis of detailed medical examiner records reveals the breadth and complexity of polysubstance drug-related deaths in the US. Future efforts to use this unique resource can improve population-based surveillance of drug-related deaths to better tailor interventions and solutions to this critical health crisis.
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