Controlled Substance Prescribing Patterns Among Fatal Overdose Decedents with an Opioid, Stimulant, or Both Contributing to Death - Pennsylvania, 2017-2022.

Psychostimulant (stimulant)-related overdose death rates have increased sharply in the United States since 2010, and in 2022, 32% of all U.S. overdose deaths involved stimulants. Data on deaths during 2017-2022 from CDC's State Unintentional Drug Overdose Reporting System were linked to 2014-2022 Pennsylvania Prescription Drug Monitoring Program data; the Pennsylvania Department of Health's Office of Drug Surveillance and Misuse Prevention analyzed controlled substance dispensation patterns during the 3 years preceding death among overdose decedents for whom opioids, stimulants, or both contributed to death; statistical analyses were performed on prescription drug dispensation patterns. Comparing overdose deaths in 2022 with those in 2017, deaths involving opioids without stimulants decreased from 2,974 to 1,995, deaths involving stimulants without opioids increased from 300 to 549, and deaths involving both opioids and stimulants increased from 1,703 to 2,346. Irrespective of whether an opioid, stimulant, or both contributed to death, decedents filled more opioid (67.7%, 74.1%, and 63.9%, respectively) than stimulant (10.6%, 11.6%, and 13.4%, respectively) prescriptions preceding death. A higher proportion of stimulant overdose decedents without an opioid contributing to death (74.1%) filled opioid prescriptions compared with decedents whose deaths involved opioids without stimulants or both opioids and stimulants (67.7% and 63.9%, respectively). Opioid prescribing, rather than stimulant prescribing, might be an important potential risk factor for stimulant-related overdose death.