Patterns of fatal polysubstance overdose: Exploratory data analysis of a convenience sample of decedents in Harris County, Texas, 2016-2025

Resumen

Aims. The current “fourth wave” of the U.S. opioid crisis is defined by increased polysubstance use, particularly fentanyl combined with stimulants, conferring greater risk of fatal overdose. This study characterized patterns of polysubstance use at time of death in a convenience sample of fatal overdose decedents. Methods. Cases were drawn from The University of Texas Health Science Center at Houston Brain Collection. Toxicology reports were obtained from the Harris County Institute of Forensic Sciences. Deaths occurred between 2016 and 2025. Metabolites were attributed to parent drugs as appropriate. Drugs were collapsed into 25 classes. Exploratory data analysis characterized the extent and heterogeneity of polysubstance use at time of death. The Gini-Simpson index quantified the diversity of the combinations (GSI = probability that two randomly selected decedents have different observed combinations). Results. Data from 73 overdose decedents were analyzed (mean age = 41.1 years; 72.6% male; 71.2% White, 19.2% Black, 8.2% Hispanic). Decedents had M = 3.5 parent drugs detected and M = 2.5 implicated as cause of death (COD), representing M = 2.8 drug classes detected and M = 2.2 implicated as COD. At least four drugs were detected in 43.8% of cases (26.0% for COD). Of 51 drug-class combinations in COD determinations, 86.3% were only observed in single cases (GSI = .96). Conclusions. Polysubstance use was pervasive, and specific combinations were heterogeneous. The simplifying assumptions required to make this complexity tractable for epidemiological or pharmacogenomic modeling may involve substantial tradeoffs between parsimony and granularity, even in much larger samples.

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Cómo citar (APA 7)

Petrovitch, D., Farrell, K., Kluwe-Schiavon, B., Stertz, L., Tran, N., Weaver, M. F., Scott D. Lane, P., Heads, A. M., Leonard, S. J., & Meyer, T. D. (2026). Patterns of fatal polysubstance overdose: Exploratory data analysis of a convenience sample of decedents in Harris County, Texas, 2016-2025. https://doi.org/10.31234/osf.io/5qzyu_v1