Assessing Prevalence of Nonmedically Used Prescription Drug Involvement in Overdose Deaths Through Linkage of State Unintentional Drug Overdose Reporting System and Controlled Substances Monitoring Program Data

While illicit substances are commonly involved in the overdose crisis, prescription substances still play a role. Oftentimes, decedents do not have prescriptions for these substances at the time of death. As such, we sought to examine the prevalence of nonmedical drug use in Tennessee through linkage of fatal drug overdose and prescription data. We used State Unintentional Drug Overdose Reporting System (SUDORS) data to identify fatal drug overdoses in Tennessee from 2019 to 2022. Deaths were linked to Controlled Substances Monitoring Program data deterministically using name and date of birth. Nonmedical use was defined as a decedent having a prescription substance on toxicology but not having an active prescription for that substance at the time of death. Descriptive statistics were performed to assess prevalence overall and examine differences between drug classes. We identified 7,281 SUDORS deaths from January 2019–2022 with complete toxicology that were able to be linked to prescription data. The median age of decedents was 40 years with 34.2% female and 65.8% males. Prevalence of nonmedical use differed for each category, 1,263(17.3%) for nonmedical opioid use, 1,216(16.7%) for nonmedical benzodiazepine use, 436 (6.0%) for nonmedical gabapentin use, and 152 (2.1%) for nonmedical stimulant use. Overtime, nonmedical use of opioids, benzodiazepines, and stimulants has decreased. Through linkage of fatal overdose and prescription data, we found the prevalence of nonmedical use to be 33% in Tennessee. Increasing education on the dangers of nonmedical use, the importance of safe drug disposal, storage, and only using medications as prescribed is encouraged to reduce improper use as the drug landscape continues to shift.