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Evaluation

Oral Presentation

Session: Lightning Session 2

Methodology for Identifying Single-drug Involved Poisoning Deaths: Application to Gabapentin-involved Drug Poisoning Death Surveillance

Tuesday, August 27, 2024
1:05 PM – 1:10 PM CEST
Location: Room III
Background: In the US, drug poisoning deaths are certified by medical examiners/coroners and the causative drugs demarcated in the death certificate literal text. The ability to identify a drug of interest as the single contributing drug in a drug poisoning death is important for drug safety research; however, identification of drug involvement based on death certificate records is severely limited by complexities in the text analysis, and lack of consensus methodology for classifying a drug poisoning death as involving single- vs polydrug.

Objectives: Describe new methodology for single- vs polydrug poisoning death classification and discuss its use in studying gabapentin involvement in drug poisoning deaths. In 2017, Kentucky became the first US state to classify gabapentin as a Schedule V controlled substance due to concerns for misuse and abuse.

Methods: In 2022, our team, in collaboration with epidemiologists from the US FDA and the CDC's National Center for Health Statistics, initiated the development of a framework for single- vs polydrug poisoning death classification. Building on the FDA/NCHS’s Drug Mention with Involvement (DMI) methodology, we further developed a program for contextual search, created an updated drug search term list with more than 12,000 search terms (including drugs, metabolites, and misspellings), and cross walked each search term to an individual drug. We classified drug poisoning deaths as single drug involved when only one drug was identified as DMI. As an applied example, we used Kentucky death certificate data, 2021-2023, to identify drug poisoning deaths (underlying cause of death in ICD10 range X40-44, X60-64, X85, Y10-Y14) with gabapentin DMI and characterized them by demographics and drug co-involvement.

Results: There were 6240 drug poisoning deaths, incl. 743 (12%) with gabapentin DMI, of which 70 (9%) also involved alcohol. The prevalence of gabapentin DMI was significantly higher among White (13%) vs non-White (5%), non-Hispanic (12%) vs Hispanic (2%), female (18%) vs male (9%), non-metro (16%) vs metro (10%) residents and increased with age. There were 12 drug poisoning deaths with gabapentin as single DMI; of these, < 5 involved alcohol. The Kentucky Chief Medical Examiner reviewed the complete medicolegal documentation for each of the 12 deaths to determine if they were likely single drug poisonings; results will be presented.

Conclusions: The proposed methodology can be implemented as a surveillance tool to detect new drug safety signals and characterize drug-related risks. The polydrug classification tools will be made freely and publicly available later this year and can have potential application in other areas of pharmacovigilance and pharmacoepidemiology.