Substance misuse and related complications have escalated at an alarming rate during the COVID-19 pandemic. Wisconsin has experienced a sustained increase in overdose mortality since 2000 with a particularly alarming increase in the last three years, exceeding national averages. Overdose mortality has increased by 70% in Wisconsin versus a national average increase of approximately 30%. Additionally, utilization of high-cost healthcare settings, such as emergency departments and hospitals, for substance-related issues continues to rise steeply. Wisconsin has experienced a 50% increase in emergency department visits for opioid overdose, placing Wisconsin in the top five states for increases in such visits for overdose. Rural residents represent a particularly at-risk population.
Toxicological analysis reveals increasing rates of polysubstance use among overdose victims and emergency department patients presenting with substance-related complications. Although much energy has been devoted to scoping polysubstance use in overdose deaths, a paucity of literature exists on polysubstance use in non-fatal overdoses. In addition to limited substance testing capability in hospital laboratories, expanded testing comes with a large cost and results are unlikely to change clinical care. Although expanded substance testing is not clinically relevant, data on polysubstance use and trends in non-fatal overdose is of great value to public health officials. In this work, we perform expanded toxicological analysis on urine specimens from emergency department patients presenting with substance-related complications. This data reveals a broader and more complex picture of the overdose epidemic than when solely focused on overdose deaths. Expanded toxicological testing also informs public health practitioners, medical providers, and the public about substance and polysubstance use trends within a community. Additionally, expanded testing may reveal novel psychoactive substances emerging within a community and enable more efficient and effective community and stakeholder education and intervention. These data complement existing data streams and allow stakeholders to identify and monitor substance use trends.