OBJECTIVE:This study examined correlates of fatality as of the time of contact with Emergency Medical Services (EMS) in a nationwide sample of opioid overdose EMS activations, with the aim of identifying salient points of intervention to reduce deaths. METHODS:We analyzed data from the 2023 National Emergency Medical Services Information System (NEMSIS) Public Release Research Data Set for 373,153 opioid overdose EMS activations (4865 identified as fatal as of the time of EMS contact). Bivariate and multivariable logistic regression models tested potential correlates of fatality, including characteristics of the patient, setting, and emergency response. RESULTS:Approximately 70.8% of fatal (versus 50.7% of nonfatal) opioid overdose EMS activations occurred in a private home. Pre-EMS bystander naloxone administration was reported in 2.3% of fatal, and 3.6% of nonfatal, cases. Adjusted odds of fatality were significantly higher for EMS opioid overdose activations in older patients (Adjusted Odds Ratio [AOR] 1.23; 95% Confidence Interval [CI] 1.11-1.37 in ages 65 + relative to ages 35-44) and in rural/wilderness (AOR 1.73; 95% CI 1.55-1.94) or suburban (AOR 1.45; 95% CI 1.28-1.63) areas versus urban areas, but significantly lower when naloxone was administered by a bystander prior to EMS arrival (AOR 0.58; 95% CI 0.48-0.70). The complaint reported to dispatch, US Census Division, and EMS unit level of care were also correlates of fatality. CONCLUSIONS:Results support the association between pre-EMS-bystander naloxone administration and lower fatality. Results also suggest the need for interventions informed by risks associated with older age, rural settings, and drug use at home.

Background Xylazine, a veterinary sedative and analgesic, has emerged as a novel adulterant in the US illicit drug supply, frequently co-occurring with fentanyl. This study examines trends in fentanyl-xylazine overdose death rates from 2018 to 2023. Methods This serial cross-sectional study examined death certificates from the CDC WONDER database to identify International Classification of Diseases, 10th Revision codes for overdose deaths likely coinvolving fentanyl (T40.4) and xylazine (T42.7 or T46.5). Crude mortality rates per 100 000 were calculated overall and by sex, race/ethnicity, US Census Divisions and state to examine demographic and geographical trends. Results Fentanyl-xylazine deaths increased from 99 in 2018 to 6020 in 2023. Crude mortality rates rose from 0.03 (95% CI 0.02 to 0.04) to 1.80 (95% CI 1.75 to 1.84) per 100 000. In 2023, rates were higher among males than females (2.63 (95% CI 2.55 to 2.71) vs 0.99 (95% CI 0.93 to 1.03) per 100 000), and higher among black than white individuals (3.21 (95% CI 3.04 to 3.38) vs 1.86 (95% CI 1.80 to 1.92) per 100 000). The Middle Atlantic and New England Census Divisions had the highest regional rates at 5.72 (95% CI 5.49 to 5.95) and 4.32 (95% CI 3.99 to 4.65) per 100 000, respectively. Discussion and conclusions The sharp increase in fentanyl-xylazine deaths, particularly among black individuals, highlights both the growing infiltration of xylazine into the illicit drug supply and persistent structural disparities in addiction treatment. Addressing this escalating epidemic requires routine toxicological testing for xylazine and expanded access to trauma-informed care, harm reduction services and interventions such as naloxone, opioid agonist therapies and wound care.

Objective: To evaluate the performance of the New Hampshire Hospital Screening and Referral Algorithm (NHHSRA) and describe the characteristics of inpatients aged 18-65 years, with serious mental illness (SMI) referred for substance use disorder (SUD) interventions. Methods: Two questions were evaluated: (1) the accuracy and utility of the NHHSRA in identifying patients appropriate for addiction-focused interventions and (2) associations between referral status and patient characteristics. Receiver operating characteristic (ROC) curve analysis evaluated diagnostic performance of the NHHSRA, with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), precision, and F1 score assessed. Logistic regressions assessed associations between patient characteristics and referral outcomes. The reference standard ("need for SUD intervention") was defined as the addiction psychiatrist's clinical assessment following direct patient evaluation. The patients assessed in this study were admitted to New Hampshire Hospital between January 2023 and February 2025. Results: The cohort (n = 927) was predominantly male (66.7%), with a mean age of 36.5 years. Opioid use disorder (OUD) was the most prevalent primary SUD (37.9%), followed by alcohol (23.9%), cannabis (15.1%), and methamphetamine (13.7%). The NHHSRA demonstrated excellent performance-sensitivity: 96.6%, specificity: 93.6%, PPV: 98.5%, NPV: 86%, and F1 score: 97.5%. ROC analysis yielded an AUC of 0.82, indicating strong discriminative ability. Logistic regressions identified higher odds of a positive NHHSRA screen among patients with OUD and lower odds among those with cannabis use disorder, after adjusting for age, sex, and psychiatric diagnosis. Conclusions: The NHHSRA is an accurate, objective tool that enhances identification of SUD intervention needs among inpatients with SMI. By addressing limitations of subjective clinical judgment and patient self-report, its implementation may improve access to addiction services and optimize treatment delivery. Patient characteristics associated with referrals inform targeted strategies for integrated care in this population. Prim Care Companion CNS Disord 2026;28(2):25m04110. Author affiliations are listed at the end of this article.

Abstract Objectives To examine the extent to which heat-related causes of death are recorded in fatal drug overdoses, how these patterns vary across states and over time, and how overdose characteristics differ between deaths with, versus without, heat involvement recorded. Methods Death certificate data for all drug overdose deaths in US residents from 2001 to 2024 (from the National Center for Health Statistics) were analyzed to identify whether a heat-related cause of death was also listed on the death certificate. Joinpoint regression, descriptive statistics, and nonparametric tests were used to examine temporal trends and compare overdose deaths with versus without recorded heat involvement. Results In 2001, fewer than 10 drug overdose deaths with recorded heat involvement were identified, but this number increased to 558 in 2024. From 2013 to 2024, mortality rates increased significantly, with an estimated annual percent change of 30.1 (95% Confidence Interval, 26.5–47.1). The highest mortality rates and numbers of deaths were observed in residents of Arizona and Nevada. American Indian/Alaska Native, Mexican-heritage, and foreign-born populations accounted for larger shares of overdose deaths with, compared to without, heat involvement recorded. A street or highway was more frequently identified as the place of injury in overdose deaths with (18.9%), versus without (2.2%) heat involvement reported. Psychostimulants such as methamphetamine were involved in 85.9% of overdose deaths with, compared to 28.9% without, recorded heat involvement. Conclusions Although representing only a fraction of all overdose deaths, fatal overdoses involving heat exposure have increased markedly over time and disproportionately impact certain states and demographic groups.

OBJECTIVES:Kratom is now widely available in the United States, yet epidemiological data remain sparse. This study examined the prevalence and correlates of kratom use among adults in the civilian noninstitutionalized US population using the most recent National Survey on Drug Use and Health (NSDUH) data. METHODS:Data from the 2021-2023 NSDUH were limited to adults aged 18+ years (n = 139,524). Weighted prevalence estimates were calculated overall, by year, and by demographic and clinical characteristics. Logistic regression models were used to examine correlates of past-year kratom use. RESULTS:The combined (2021-2023) weighted prevalence of past-year kratom use among US adults was 0.68% (95% CI, 0.60%-0.77%), remaining stable across survey years. Kratom use was more common among males, adults aged 26-49, and non-Hispanic white or multiracial adults. Prevalence exceeded 2% among adults reporting serious psychological distress or a major depressive episode, and exceeded 5% among those reporting certain types of substance use or prescription medication misuse. In covariate-adjusted analyses, higher odds of kratom use were observed among men, adults aged 35-49 years, and those reporting prescription pain reliever use or misuse, as well as cigarette, cannabis, and ketamine use, whereas lower odds were observed among black and Hispanic adults compared with white adults. CONCLUSIONS:Kratom use among adults in the United States was relatively stable between years 2021 and 2023 and concentrated among individuals with reported psychological distress and substance use. Future studies should include more comprehensive assessments of kratom use, and screening for kratom use in high-risk clinical populations may be warranted.

OBJECTIVES:To examine the extent to which heat-related causes of death are recorded in fatal drug overdoses, how these patterns vary across states and over time, and how overdose characteristics differ between deaths with, versus without, heat involvement recorded. METHODS:Death certificate data (from the National Center for Health Statistics) for all drug overdose deaths in US residents, 2001-2024, were analyzed to identify whether a heat-related cause of death was also listed on the death certificate. Joinpoint regression, descriptive statistics, and nonparametric tests were used to examine temporal trends and compare overdose deaths with versus without recorded heat involvement. RESULTS:In 2001, fewer than 10 drug overdose deaths with recorded heat involvement were identified, but this number rose to 558 in 2024. Mortality rates for overdoses with recorded heat involvement increased from 2013 to 2024 with an estimated annual percent change of 30.1 (95% confidence interval, 26.5-47.1); the highest mortality rates and numbers of deaths were observed in residents of Arizona and Nevada. American Indian/Alaska Native, Mexican-heritage, and foreign-born populations accounted for larger shares of overdose deaths with, compared with without, heat involvement recorded. A street or highway was more frequently identified as the place of injury in overdose deaths with (18.9%), versus without (2.2%) heat involvement reported. Psychostimulants such as methamphetamine were involved in 85.9% of overdose deaths with, versus 28.9% without, recorded heat involvement. CONCLUSIONS:Although representing only a fraction of all overdose deaths, fatal overdoses with recorded heat involvement have increased, disproportionately impacting certain states and demographic groups.

BACKGROUND:This study examined which characteristics of substance use disorder (SUD) treatment facilities and their surrounding areas are associated with offering overdose education and naloxone (OEN). METHODS:We linked data from eight national sources regarding 12,146 SUD treatment facilities (from the 2024 National Directory of Drug and Alcohol Use Treatment Facilities) and the communities and states where they operate. Regression analyses tested whether facility OEN provision was associated with facility type (with cluster analysis used to group facilities based on services offered) and selected facility, ZIP code, and state characteristics. FINDINGS:In a generalized linear mixed model, odds of OEN provision were higher in facilities that: used medications for opioid use disorder (Adjusted Odds Ratio [AOR] 7.21; 95% Confidence Interval [CI] 5.97-8.71); offered testing for HIV/hepatitis (AOR 2.39; 95% CI, 2.00-2.86); were government-operated (AOR 2.37; 95% CI, 1.81-3.11) vs. private for-profit; accepted Medicaid (AOR 2.36; 95% CI, 2.01-2.77); or were in metropolitan (vs. non-metropolitan) areas (AOR 1.27; 95% CI, 1.06-1.53). In facility cluster analysis (based on 191 facility characteristics/services), adjusted odds of OEN provision were lowest in the cluster characterized by outpatient services, low use of medications for opioid use disorder, and few social/medical/tailored services. Odds of OEN provision were highest in the cluster characterized by offering "detoxification," residential care, buprenorphine and naltrexone, and comprehensive medical and social services. CONCLUSIONS:OEN provision is lowest in SUD treatment facilities that do not use medications for opioid use disorder, offer relatively few social or medical services, and/or are located in non-metropolitan areas.

A community-based participatory research approach was used to understand experiences and effective support systems utilized during the COVID-19 pandemic among American Indian adults (N = 30) living on an Arizona Tribal reservation. Individual interviews were conducted between October 2022 and April 2023, and interview data were collected and analyzed by researchers who are citizens of the Tribe of focus. Findings indicate a continued need to plan for emergency food and water; the importance of elected district representatives; and a returning to and/or increased use of cultural activities, religious and/or spiritual practices to reduce stress, grief, and isolation. Results may be applicable to other Tribal or rural-based communities in the Southwest and beyond.

Background Drug overdose deaths decreased in the United States overall from 2023 to 2024, yet provisional data suggest a subsequent increase in overdose deaths in the southwestern state of Arizona. To better understand this pattern, we compared Arizona overdose death counts in the most recent months available and in previous years. Methods We analyzed monthly drug overdose death counts (overall and by demographic and drug type) from the Centers for Disease Control and Prevention for deaths that occurred in Arizona from January 2018-August 2025. Results Arizona overdose deaths in January, February, March, and April 2025 reached the highest monthly totals recorded for these months across all years examined (2018-2025). The provisional number of overdose deaths in Arizona from January-August 2025 (2,034) was 20% higher than in January-August 2024 (1,689), and percent increases were most pronounced in ages 18-24 (increasing 35% from 69 to 93), ages 25-34 (increasing 29% from 328 to 423), ages 35-44 (increasing 28% from 414 to 530), and Hispanic (increasing 43% from 443 to 634) and Non-Hispanic Black (increasing 25% from 154 to 193) populations. Increases between January-August 2024 and January-August 2025 were observed across deaths involving synthetic opioids such as fentanyl (increasing 40% from 996 to 1,396), psychostimulants such as methamphetamine (increasing 23% from 1,005 to 1,233), and cocaine (increasing 66% from 177 to 294). Conclusions Nationwide declines in overdose deaths are encouraging but may obscure potential rebounds at the state/local level, and sustained investment is warranted in evidence-based harm reduction and overdose prevention programs.

BACKGROUND:People with disabilities (PWD) are at higher risk of experiencing substance use (SU) disorders than those without a disability. While treatment for SU reduces mortality and morbidity, currently there are no national-level studies comparing US adults with and without disabilities in terms of SU treatment receipt, perceived need, and barriers. OBJECTIVE:To examine differences between US adults with and without disabilities in terms of SU treatment receipt, perceived need for treatment, and barriers to receiving treatment. METHODS:This cross-sectional study examined National Survey on Drug Use and Health (NSDUH) 2022-2023 data (n = 89,167 adults) on self-reported disability and past-year substance use disorder (SUD), SU treatment, unmet treatment need, and treatment barriers. Analyses included weighted prevalence estimates, chi-squared tests (corrected for the survey design), and binomial logistic regression. RESULTS:An estimated 10.0 % of adults with a disability, versus 3.9 % without a disability, reported receiving past-year SU treatment. For adults with a past-year SUD who did not receive treatment, reporting a disability was associated with 70 % higher odds (Adjusted Odds Ratio [AOR] 1.70; 95 % Confidence Interval [CI], 1.27-2.28) of "unmet need" for SU treatment (after adjusting for demographics). Among adults who reported an "unmet need" for SU treatment, barriers related to cost and stigma were reported more frequently in those with, compared to those without, a disability. CONCLUSIONS:Findings highlight elevated SU treatment need and barriers for PWD. Understanding the intersection of disability with the cascade of care, from screening to diagnosis and treatment of SU, is critical in improving health outcomes.

BACKGROUND:This study examined which specific sociodemographic groups are most affected by drug overdose deaths in the United States (US). METHODS:The study consisted of a cross-sectional analysis of US death certificate data (2018-2023) from 512,198 drug overdose deaths. We calculated drug overdose mortality rates and proportionate mortality for subpopulations formed based on the concurrent intersection of detailed race/ethnicity, sex, age, nativity, and educational attainment. RESULTS:In the US, 2018-2023, of all subpopulations examined, male foreign/territory-born Puerto Rican Americans ages 35-49 with a high school education or lower experienced the highest estimated drug overdose mortality rate (261.9 per 100,000) and highest overdose proportionate mortality (with overdoses accounting for 42.8 % of all deaths in the group). Following this group, the highest overdose mortality rates (per 100,000) were observed in: male US-born Non-Hispanic (NH) American Indian/Alaska Native Americans ages 35-49 with a high school education or lower (235.2); male foreign/territory-born Puerto Rican Americans ages 50-64 with a high school education or lower (218.4); and male US-born NH Black Americans ages 50-64 with a high school education or lower (213.2). Elevated overdose proportionate mortality was observed in female US-born NH White-and-Black Americans ages 21-34 with a high school education or lower and male US-born South Americans ages 21-34 with a high school education or lower (with overdoses accounting for 42.2 % and 42.1 % of all deaths in these groups, respectively). CONCLUSIONS:Low educational attainment intersects with risks related to age, sex, nativity, and racial/ethnic identification to shape disparities in US drug overdose deaths.

This study explored whether law enforcement/first responder-reported fentanyl overdose response actions (such as administration of the opioid overdose reversal agent naloxone) differed between overdoses in which xylazine was, versus was not, suspected to be co-involved. Data were drawn from the Pennsylvania State Police's Overdose Information Network (ODIN) for 11,478 suspected fentanyl-involved overdoses, 137 reportedly co-involving xylazine, recorded across Pennsylvania (January 2018-January 16, 2025), excluding Philadelphia. We used relative frequencies, Fisher's exact tests, and binomial logistic regression to compare first responders' overdose response actions in suspected fentanyl overdose cases in which xylazine was, versus was not, reportedly co-involved. Naloxone was administered at the scene of 46.0% of the overdoses reportedly involving fentanyl and xylazine, vs. 67.3% of the reported fentanyl-no-xylazine overdoses. Multivariable regression results (among the suspected fentanyl overdoses in ODIN, adjusting for age, sex, race/ethnicity, year, county rurality, and other drugs suspected to be involved) indicated that suspected xylazine co-involvement was associated with 60% lower odds of naloxone administration (adjusted odds ratio, 0.40; 95% confidence interval, 0.28-0.57). Observed differences in overdose response based on suspected xylazine co-involvement support the importance of equipping first responders with the tools and training to recognize/manage the distinct challenges of xylazine-fentanyl-involved overdose.

Xylazine and medetomidine are α2-adrenergic receptor agonists and sedatives that have recently emerged as adulterants in the U.S. illicit drug supply, complicating public health monitoring and response. In this cross-sectional study, we used data from the Drug Enforcement Administration's (DEA) National Forensic Laboratory Information System (NFLIS) from 1999 to 2024 to examine temporal and geographic trends in detections of these substances. We also identified the ten most common "co-reported" drugs, defined as substances found in the same seizures as xylazine or medetomidine that were submitted to NFLIS; however, these should not be interpreted as true polysubstance mixtures since they were not necessarily physically mixed. Overall, we found that xylazine reports increased from just 2 in 1999 to 149 in 2015, then surged from 9,330 in 2021 to 25,047 in 2024, with the past four years accounting for more than 90 % of all xylazine reports. Similarly, medetomidine reports rose from 12 in 2021 to 245 in 2023, then substantially increased to 2,276 in 2024. This increase was largely driven by the Northeast, where medetomidine reports increased from 5 in 2023 to 1,633 in 2024. Fentanyl was co-reported in 52.9 % of xylazine and 63.6 % of medetomidine reports, with the highest shares in the Northeast at 78.7 % and 89.1 %, respectively. These findings underscore the rapid spread of xylazine and medetomidine in the illicit drug market and their frequent co-reporting with fentanyl, highlighting the need for further public health surveillance and widespread distribution of harm reduction services to continue monitoring their spread across the U.S.

Objective:In 2020, Black Americans became one of the racial/ethnic groups with the highest drug mortality rates, yet factors driving this trend remain unclear. Given the increasing participation of Black workforce in the construction sector during the 2010s-a sector that typically offers livable wages without requiring college degrees-this study examines whether changes in the concentration of local construction sector jobs are associated with variations in drug mortality among Black Americans across U.S. counties. Methods:Data were drawn from the National Center for Health Statistics' Multiple Cause of Death file, linked with construction job shares, drug supply, and sociodemographic characteristics from other administrative data sources. After examining county characteristics based on changes in construction job shares from 2010-2013 to 2018-2021, first-difference regression models assessed the effects of construction job shares on drug mortality rates among overall and working-aged Black populations. Results:A 1 percentage point increase in construction job shares was associated with a reduction of 6.67 drug-related deaths per 100,000 among Black residents, with a larger effect (10.32 deaths) among working-aged individuals. Over the study period, this translates to a shift in drug mortality rates from an increase of 38.2 deaths per 100,000 in counties with a 0.5 percentage point decline in construction job shares to a decrease of 1.8 deaths per 100,000 in counties with a 5.5 percentage point increase. Conclusions:Growing employment opportunities in the construction sector may provide population-level protection against drug mortality for Black Americans, particularly among the working-aged population.

This study examines the role of recovery homes in supporting individuals with substance use disorders and their transition to independent living. It highlights the challenges related to licensing, regulation, and stigma surrounding medication for opioid use disorder (MOUD) within recovery homes. A survey was conducted among recovery home affiliates in Arizona to assess their understanding of licensing requirements and attitudes toward MOUD. The results indicate a need for standardized regulations, increased acceptance of MOUD, and resources to meet licensing requirements. Favorable attitudes toward MOUD were associated with higher odds of having organizational resources to meet licensing requirements. These findings emphasize the importance of addressing stigma, promoting favorable attitudes, and ensuring quality care in recovery homes. Future research should explore barriers and facilitators to MOUD acceptance and implementation in recovery homes.

In consideration of recent US substance use treatment policy changes and unprecedented levels of adolescent opioid-related deaths, we examined the most recent national data (2022-23 National Survey on Drug Use and Health, 2022 Treatment Episode Data Set-Admissions, and 2023 National Substance Use and Mental Health Services Survey) on adolescent opioid use disorder (OUD)-related treatment. Only 30.8 percent of adolescents (ages 12-17) with OUD reported receiving any past-year substance use treatment. Criminal-legal system referrals were more prevalent in adolescent (27.8 percent) than adult (17.0 percent) opioid-related treatment admissions; medications for OUD were included in a lower share of adolescent (9.5 percent) versus adult (36.4 percent) admissions. Fewer than one in four (23.3 percent) OUD treatment facilities reported offering an adolescent-tailored group or program, and the numbers of facilities with adolescent-tailored programs varied widely by state and program type. These results highlight opportunities for local and national policies or programs regarding adolescent OUD screening and care coordination, treatment quality, and accessibility.

Aims: Extreme heat has been rising in cities worldwide, but relatively little is known about heat-related drug overdose deaths in the era of fentanyl and stimulants. Therefore, we examined overdose deaths with heat involvement recorded in one of the hottest US states-Arizona. Method: We analyzed data from the Arizona State Unintentional Drug Overdose Reporting System for all 12,384 Arizona unintentional/undetermined intent overdose deaths recorded in ages 15+, 2019-2023. The primary outcome was whether heat involvement was recorded as a cause of death. We examined monthly and yearly numbers of overdose deaths with heat involvement recorded and used logistic regression to test sociodemographic and toxicology correlates of heat involvement in overdose deaths. Results: Heat involvement was recorded in 7 % of Arizona overdose deaths (unintentional/undetermined intent, ages 15+) from 2019-2023 and 33 % of overdose deaths that occurred during July. Heat involvement was recorded in 3 % of overdose deaths in 2019 and 15 % of overdose deaths in 2023. Approximately 60 % of those who died of overdoses with heat involvement recorded were identified as experiencing homelessness. Among overdose deaths, adjusted odds of recorded heat involvement were higher in decedents with methamphetaminepositive toxicology (adjusted Odds Ratio [aOR] 3.58, 95 % Confidence Interval [CI] 2.61-4.92) and those experiencing homelessness (aOR 8.34, 95 % CI 6.74-10.32). Conclusions: Results document rising overdose deaths with heat involvement reported in Arizona, as well as key sociodemographic and drug-related risks overrepresented in these deaths, supporting the need for public health initiatives informed by intersectional risks of heat exposure, homelessness, and methamphetamine use.

A community-based participatory research approach was used to understand COVID-19 and long COVID-19 experiences, current health needs, and health messaging strategies among Indigenous adults living on a Tribal reservation in Arizona. Researchers who are citizens of the Tribe of focus conducted and analyzed data from 30 individual interviews held virtually and by phone between October 2022 and April 2023. Findings indicate a need for support services to alleviate issues of grief and loss negatively affecting participants' quality of life, including a need for increased access to community-based substance use disorder in-patient treatment services, relapse prevention services, opiate overdose training with Narcan distribution, as well as community-based information on long COVID-19. Overall, results can help to inform individual- and community-level health decision-making behaviors, as well as provide culturally grounded health messaging strategies, which may be applicable to other Tribal, reservation, or rural-based communities in the Southwest and beyond.

OBJECTIVE:This study examined drug overdose deaths in Mexican-heritage Arizonans, with the goal of informing tailored overdose prevention programs for this community. METHODS:We analyzed death certificate data (from the Arizona Department of Health Services) for drug overdose deaths among Arizona residents from 2018-2022. We compared deaths in US-born and foreign-born Mexican-heritage Arizonans and, as a frame of reference, Non-Hispanic (NH) White Arizonans. We compared demographics, circumstances of death, and mortality rates, using descriptive statistics, multinomial logistic regression models, and age-standardized mortality rates and ratios. RESULTS:The age-standardized drug overdose mortality rate (per 100,000) was lower in the overall Mexican-heritage population (28.0) than in the NH White population (35.9). Nonetheless, the rate in the US-born Mexican-heritage male subgroup (59.5) was higher than in US-born NH White males (49.9) or any other subgroup examined. Synthetic opioids such as fentanyl were involved in higher proportions of deaths among US-born (64.6%) and foreign-born (65.1%) Mexican-heritage Arizonans than among NH White Arizonans (48.5%). In multinomial regression models, the risk of a medical place of death, relative to death at home, was significantly higher in the foreign-born (adjusted Relative Risk Ratio [aRRR] 1.82; 95% Confidence Interval [CI], 1.38-2.42) and US-born (aRRR 1.85; 95% CI, 1.62-2.11) Mexican-heritage groups than the NH White group, adjusting for age, sex, marital status, county of residence, overdose intent, and drugs involved. CONCLUSIONS:Findings highlight disparate rates of overdose mortality in US-born Mexican-heritage Arizona men, also underscoring racial/ethnic/nativity-based differences in overdose circumstances and decedent characteristics.

Some of the highest youth drug mortality rates have been recorded in the US southwest state of Arizona. In this descriptive report, we analyzed death certificate data from 1,584 Arizona residents aged 12-25 who died of drug overdose from 2018-2022. We calculated yearly mortality rates, compared characteristics of deaths in adolescents (12-17) versus young adults (18-25) using chi-squared tests, and examined deaths involving different drug combinations. By drug combination category, the "no synthetic opioid" group had the highest share of intentional deaths (15.7%) and Non-Hispanic White (54.1%) or female (32.8%) decedents. The "synthetic opioid only" group was the largest group (47.7%) and had the highest percentage of adolescents ages 12-17 (14.8%), Hispanics (50.3%), and deaths that occurred at home (46.4%). The "synthetic opioids with stimulants" group was concentrated in the most recent years (2021-2022) and primarily comprised young adults (95.6%). Overall, drug overdose mortality rates peaked in 2020 for both Arizona adolescents and young adults. Compared to young adults, overdose deaths in adolescents included a higher share of suicides and lower share of heroin, cocaine, or methamphetamine-type-psychostimulants. In both adolescent and young adult overdose deaths, synthetic opioids such as fentanyl were implicated in more than three of every four deaths.