(SLB-040) Polypharmacy and Drug Combinations Associated with Unintentional Drug Overdose in the United States

Background: Unintentional drug overdoses are a leading cause of morbidity/mortality in the U.S. Despite the growing use of polypharmacy, evidence on the underlying cause of these overdoses has been limited to specific medications and medication combinations, including opioid analgesics, benzodiazepines, and stimulants, often associated with drug abuse and misuse.

Objectives: To characterize common patterns of medications and medication combinations used among individuals with unintentional drug overdoses in the U.S.

Methods: We identified individuals within IQVIA Dx/Hx medical and institutional claims data who experienced an unintentional drug overdose in 2019. Using a self-controlled study design, we analyzed the most common medications and medication combinations during the 60-days preceding the index date for the 'case' and 'control' periods. The index-date for the 'case' period is the date of the incident, drug overdose event, while the index date for the 'control' period is 12-months prior to the event. We used machine learning approaches (e.g., FP-growth) to identify medication patterns, overall and by subgroup, including by sex, substance use disorder, and depression diagnosis.

Results: We identified a total of 29,977 individuals 12 years or older with an incident, unintentional drug overdose in the U.S.; 42.9% were male, 68.9% were 40 years or older. The majority (~88%) of individuals used five or more medications concurrently within 60-days prior to having an overdose. More than one-third (38.5%) of individuals were previously diagnosed with depression and thirty percent have a history of substance use disorder. Overall, albuterol (2.0%) and gabapentin (1.8%) were among the five most common medications; Oxycodone and hydrocodone (opioid analgesics) were also in the top five but were used by 1.5% of individuals. These patterns varied by gender and among those with depression and substance use disorder; levothyroxine and sertraline were more commonly used in combinations in women whereas amphetamines and oxycodone were more common in men. Albuterol and gabapentin were common in those with substance use disorder.

Conclusions: Although efforts to address drug overdose has focused on opioids, benzodiazepines and stimulants, our findings indicate that other commonly used medications, particularly for the treatment of depression, asthma, and hypertension, are frequently used alone or combination preceding an unintentional overdose among US individuals.