The ability to monitor trends in drug poisoning (also commonly referred to as “overdose”) mortality where a substance of interest was the only substance mentioned with involvement (vs. polysubstance involvement) is important for informing policy and regulatory decisions.
This project aimed to:

1. Develop a framework for classifying drug poisoning deaths (i.e., drug overdose deaths) as single- versus polydrug poisoning deaths, building on the NCHS/FDA Drug Mentioned with Involvement (DMI) methodology (Trinidad et al., 2016)

2. Upgrade the NCHS DMI programs (CDC, 2019) to a new analytical tool, DMI2EpiTool, that can be used by surveillance epidemiologists and researchers to monitor the involvement of specific drugs in drug poisoning mortality and identify single- vs. poly- drug poisoning deaths

In 2016, the Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS), in collaboration with the U.S. Food and Drug Administration (FDA) developed a methodology for analysis of literal text on U.S. electronic death certificates to identify specific drugs mentioned with involvement (DMI) (Trinidad et al., 2016). The DMI methodology uses a drug search term list (including drug names, metabolites, and misspellings cross-walked to generic drug names) and contextual phrases to capture specific drugs identified by medical examiners/coroners as contributing to drug poisoning deaths and listed on the death certificate.

To date, the use of the DMI methodology has been limited to a few NCHS publications tracking changes in drugs most frequently involved in U.S. drug overdose deaths (Hedegaard et al., 2018; Hedegaard et al., 2019; Trinidad et al., 2016; Warner et al., 2016).

Our project built on the existing DMI methodology to develop a polydrug poisoning death classification framework and an analytical toolbox (including programming code, guide, test dataset) to facilitate drug-involved reporting and research.

CDC. (2019). National Vital Statistics Mortality Data. Drug Mentions with Involvement Programs. Available from https://github.com/CDCgov/National-Vital-Statistics-Mortality-Data.

Hedegaard, H., Bastian, B. A., Trinidad, J. P., Spencer, M., & Warner, M. (2018). Drugs Most Frequently Involved in Drug Overdose Deaths: United States, 2011-2016. Natl Vital Stat Rep, 67(9), 1-14. https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_09-508.pdf

Hedegaard, H., Bastian, B. A., Trinidad, J. P., Spencer, M. R., & Warner, M. (2019). Regional Differences in the Drugs Most Frequently Involved in Drug Overdose Deaths: United States, 2017. Natl Vital Stat Rep, 68(12), 1-16. https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/NVSR/68_12/Table.xlsx

Trinidad, J. P., Warner, M., Bastian, B. A., Minino, A. M., & Hedegaard, H. (2016). Using Literal Text From the Death Certificate to Enhance Mortality Statistics: Characterizing Drug Involvement in Deaths. Natl Vital Stat Rep, 65(9), 1-15.

Warner, M., Trinidad, J. P., Bastian, B. A., Minino, A. M., & Hedegaard, H. (2016). Drugs Most Frequently Involved in Drug Overdose Deaths: United States, 2010-2014. Natl Vital Stat Rep, 65(10), 1-15.

This work was funded by the U.S. Food and Drug Administration (FDA; 75F40122C00193). The contents are solely the responsibility of the authors and do not necessarily represent the official views of the FDA. The authors acknowledge support from the Kentucky Cabinet for Health and Family Services (CHFS) Office of Vital Statistics, the CHFS Office of Inspector General, and the Kentucky Chief Medical Examiner.