Methods: Data were obtained from the Mid-Michigan Medical Examiner Group to examine postmortem toxicology results from overdose deaths that occurred between January 1, 2018, and December 31, 2020 in 11 rural counties. Data from death certificates provided sociodemographic information while toxicology data provided detection on all substances present at the time of death. Among 107 deaths that occurred over the three-year period we examined the detection of fentanyl, heroin, prescription opioids, cocaine, methamphetamine, and benzodiazepines. Binary logistic regression modeling was also performed.
Results: Most decedents were male (72.9%), White (96.3%), non-military (96.3%), employed (29.0%), never married (27.1%), and had a mean age of 47 years old. The place of death most often reported was the decedent’s residence (69.2%), follow by ER/Outpatient (12.1%), other residence (11.2%), and Other (7.5%). Approximately 38.3% of deaths were reported to have a syringe(s) present and nearly 64.0% had other paraphernalia present. Fentanyl was overwhelmingly the most common substance detected and a 94% increase during the three-year period to present in 70% of all the deaths in these counties in 2020. Among the deaths where cocaine was detected, 69% also contained fentanyl, and in deaths where methamphetamine was detected, 77% also contained fentanyl. Our binary logistic regression model indicated that dying of a fentanyl-involved overdose was nearly four times greater (OR = 3.8; 95% CI=2.2-12.6) when syringe(s) were found at the scene of death.
Conclusion and Implications: The lack of a “safe supply” is driving overdose increases, as people who use illicit opioids have shifted from prescription medications, to heroin, to heroin (and potentially other substances) contaminated with fentanyl. Drug checking can provide people who use drugs the ability to identify the presence of fentanyl in unregulated drugs. Being aware if fentanyl is present is a powerful overdose prevention tool and allows people to implement appropriate harm reduction strategies to reduce the risk of an overdose.