Trends in accidental poisoning and exposure to noxious substances involving drugs, medicaments, and biological substances-related deaths: A nationwide US analysis, 1999 to 2023.

Unintentional poisoning and exposure to harmful substances involving illicit drugs, medications other than those taken as prescribed, and biological substances have emerged as a leading cause of preventable death in the United States. The increase in drug-specific toxicity, particularly from synthetic opioids, has accelerated during the COVID-19 pandemic, thus highlighting a need for national surveillance to monitor emerging demographic and geographic patterns. The CDC WONDER Multiple Cause of Death database provided mortality data from 1999 to 2023. Deaths with accidental poisoning (International Statistical Classification of Diseases and Health-Related Problems-10th Revision codes X40-X49) coded as the underlying cause and poisoning due to drugs (T36-T50) as multiple causes were considered. Age-adjusted mortality rates were extracted from the SEER database (number of deaths per 100,000 individuals). They were analyzed according to sex, age strata, race/ethnicity, and geographic region via Joinpoint regression for estimation of annual percentage change and average annual percentage change, with statistical significance set at P < .05. From 1999 to 2023, all-ages age-adjusted mortality rates more than sextupled, from 4.8 (95% confidence interval: 4.7-4.9) to 30.8 (95% confidence interval: 30.6-31.0). The consistently higher male mortality culminated in 2022, where men had a crude mortality of 45.3 per million compared with 18.2 per million in women. The largest increase was from 2019 to 2020, after the start of the COVID-19 pandemic. It is most severe among middle-aged adults (ages 45-64) and is characterized by geographic disparities in mortality, with clustering in counties across the Appalachian region and Southern United States. Non-Hispanic Black and American Indian/Alaska Native people experienced the latest spikes in mortality. The ongoing rise in drug-related accidental poisonings indicates a growing, evolving epidemic in the United States. The findings identified a need for focused equity-based interventions targeting substance use treatment, social determinants of health, and enhanced surveillance to address the escalating burden of mortality due to drug toxicity.