Geographic variation and trends in opioid-involved crash deaths in Maryland: 2006-2017.

The objective of this study was to describe trends in the prevalence of opioids in driver fatalities and examine geographic variation in opioid-involved crashes at a county level. Using comprehensive toxicological data from the Office of the Chief Medical Examiner in Maryland, we examined the prevalence of opioids in all motor vehicle crash fatalities in Maryland between 2006-2017 and tested for trends to assess the statistical significance of changes in the prevalence of prescription opioids detected in these drivers over time. Opioid-involved crash deaths accounted for 10.0% of all driver deaths during the study period. The prevalence of opioids detected in fatally injured drivers increased from 8.3% in 2006 to 14.1% in 2017, (Z = -1.9, p < .05). The trends in opioid deaths do not follow broader trends in motor vehicle crash deaths; opioid-involved crashes appear to be increasing while overall motor vehicle crashes appear to be decreasing over the same period. To determine if the increase in opioid-involved crash deaths was the result of changes in pain management related to injuries sustained from the crash, we analyzed a subgroup of cases where death occurred at the scene of the crash. Within this group, there was no statistically significant increase in opioid-involved crashes during the study period. Opioid prevalence was higher in middle aged, and white drivers, and in crashes occurring in rural counties. Geographic distribution of opioid-involved crash deaths reflect broader patterns of opioid deaths overdose across the state. Irrespective of the timing of the deaths, of the drivers testing positive for opioids, 28% had elevated blood alcohol concentrations (‡ 0.01 g/dL), and 45% tested positive for other drugs.