Heroin and fentanyl overdoses in Kentucky: Epidemiology and surveillance

Svetla Slavova, Julia F. Costich, Terry L. Bunn, Huong Luu, Michael Singleton, Sarah L. Hargrove, Jeremy S. Triplett, Dana Quesinberry, William Ralston, Van Ingram

Research output: Contribution to journalArticlepeer-review

68 Scopus citations


Background The study aims to describe recent changes in Kentucky's drug overdose trends related to increased heroin and fentanyl involvement, and to discuss future directions for improved drug overdose surveillance. Methods The study used multiple data sources (death certificates, postmortem toxicology results, emergency department [ED] records, law enforcement drug submissions, and prescription drug monitoring records) to describe temporal, geographic, and demographic changes in drug overdoses in Kentucky. Results Fentanyl- and heroin-related overdose death rates increased across all age groups from years 2011 to 2015 with the highest rates consistently among 25–34-year-olds. The majority of the heroin and fentanyl overdose decedents had histories of substantial exposures to legally acquired prescription opioids. Law enforcement drug submission data were strongly correlated with drug overdose ED and mortality data. The 2016 crude rate of heroin-related overdose ED visits was 104/100,000, a 68% increase from 2015 (62/100,000). More fentanyl-related overdose deaths were reported between October, 2015, and September, 2016, than ED visits, in striking contrast with the observed ratio of >10 to 1 heroin-related overdose ED visits to deaths. Many fatal fentanyl overdoses were associated with heroin adulterated with fentanyl; <40% of the heroin overdose ED discharge records listed procedure codes for drug screening. Conclusions The lack of routine ED drug testing likely resulted in underreporting of non-fatal overdoses involving fentanyl and other synthetic drugs. In order to inform coordinated public health and safety responses, drug overdose surveillance must move from a reactive to a proactive mode, utilizing the infrastructure for electronic health records.

Original languageEnglish
Pages (from-to)120-129
Number of pages10
JournalInternational Journal of Drug Policy
StatePublished - Aug 2017

Bibliographical note

Publisher Copyright:
© 2017 Elsevier B.V.


  • Fentanyl
  • Heroin
  • Overdose
  • Surveillance

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Health Policy


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