{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T21:22:49Z","timestamp":1793395369950,"version":"4.5.0"},"reference-count":34,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2024,1,30]],"date-time":"2024-01-30T00:00:00Z","timestamp":1706572800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Inj Prev"],"accepted":{"date-parts":[[2023,10,30]]},"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>US drug overdose deaths are at historic levels. For every fatal drug overdose, there are many more non-fatal; however, minimal nationally representative data exist on trends in the ratio of fatal to non-fatal drug overdoses and how this differs by drug type.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Data from the Centers for Disease Control and Prevention\u2019s National Vital Statistics System were used to assess the number of fatal overdoses; data from the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample database were used to estimate the number of non-fatal overdoses treated in emergency departments. Counts of fatal and non-fatal overdoses by drug type (all drug, all opioid, synthetic opioid, heroin, stimulant, and opioid and stimulant polysubstance) were calculated from 2010 to 2020 (for non-fatal synthetic opioid-involved overdoses, from 2016 to 2020 only). Trends in overdose counts and the ratio of fatal to non-fatal overdoses were assessed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>On average, counts of fatal overdoses increased quarterly among all drug types, and non-fatal overdoses increased among most drug types. Over the 11-year period, the greatest average quarterly percent change (AQPC) in fatal overdose counts was among synthetic opioid-involved overdoses (AQPC: 7.1%; 95%\u2009CI: 6.0 to 8.2) and for non-fatal overdoses was among heroin-involved overdoses (AQPC: 4.3%; 95%\u2009CI: 3.9 to 4.8). During 2010\u20122020, there was approximately 1 fatal overdose per 15 non-fatal. The ratio of fatal to non-fatal drug overdoses increased among every drug type except heroin; ratio increases were driven by greater relative increases in fatal overdoses compared with non-fatal.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Assessment of the ratio of fatal to non-fatal drug overdoses can be used to understand the lethality of different drugs and inform response and prevention efforts.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/ip-2023-045091","type":"journal-article","created":{"date-parts":[[2024,1,30]],"date-time":"2024-01-30T13:07:32Z","timestamp":1706620052000},"page":"114-124","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":49,"title":["Estimating the ratio of fatal to non-fatal overdoses involving all drugs, all opioids, synthetic opioids, heroin or stimulants, USA, 2010\u20132020"],"prefix":"10.1136","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7819-910X","authenticated-orcid":false,"given":"Shannon M","family":"Casillas","sequence":"first","affiliation":[{"name":"National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3154-2374","authenticated-orcid":false,"given":"Cassandra M","family":"Pickens","sequence":"additional","affiliation":[{"name":"National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4191-7427","authenticated-orcid":false,"given":"Lauren J","family":"Tanz","sequence":"additional","affiliation":[{"name":"National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4576-1156","authenticated-orcid":false,"given":"Alana M","family":"Vivolo-Kantor","sequence":"additional","affiliation":[{"name":"National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,1,30]]},"reference":[{"key":"2025092509474336000_30.2.114.1","doi-asserted-by":"crossref","unstructured":"National Center for Health Statistics . Drug overdose deaths in the United States, 2001\u20132021. Hyattsville, MD, 2022. doi:10.15620\/cdc:122556","DOI":"10.15620\/cdc:122556"},{"key":"2025092509474336000_30.2.114.2","doi-asserted-by":"crossref","first-page":"897","DOI":"10.15585\/mmwr.mm6634a2","article-title":"Trends in deaths involving heroin and synthetic opioids excluding methadone, and law enforcement drug product reports, by census region - United States, 2006-2015","volume":"66","author":"O\u2019Donnell","year":"2017","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2025092509474336000_30.2.114.3","article-title":"Illicitly manufactured fentanyl entering the United States","volume":"13","author":"Pergolizzi","year":"2021","journal-title":"Cureus"},{"key":"2025092509474336000_30.2.114.4","unstructured":"Centers for Disease Control and Prevention . Increase in fatal drug overdoses across the United States driven by synthetic opioids before and during the COVID-19 pandemic. 2020. 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