Magnolia Center Charleston

03/10/2026

Route of drug use among North Carolina drug overdose decedents, 2018–2023
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Molly Remch a
,
Mary E. Cox b
,
Scott Proescholdbell b
,
Darsey Schulaka b
,
Kathryn E. Moracco c d

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https://doi.org/10.1016/j.ypmed.2026.108546
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Highlights
•
Analyses of overdose deaths in North Carolina from 2018 to 2023.
•
Overdoses involving injection have decreased as a percent of overdose deaths.
•
Overdoses involving snorting and smoking have increased as a percent of overdose deaths.
•
Trends differ by race, s*x, and age.
Abstract
Objective
To describe the route of drug use among overdose decedents in North Carolina.
M**hods
We use data from the North Carolina State Unintentional Drug Overdose Reporting System from 2018 to 2023. We include variables on the characteristics of the decedents and context of the overdose, including the reported route of drug use and the drugs involved.
Results
There were 19,520 overdose deaths, largely involving opioids (87.7%), particularly fentanyl and its analogues (75.5%), stimulants (61.3%), and benzodiazepines (20.9%). Route of drug use was not documented for most (53.9%) deaths. In 2018, the most common route of drug use among decedents was injection (36.6%), followed by snorting (6.3%), smoking (3.6%), and ingestion (1.7%). In 2023, the percentage of overdose deaths involving injection (18.1%), snorting (17.8%), and smoking (18.3%) were similar to one another and the prevalence of ingestion increased to 4.7%.
Conclusions
Increasing numbers of overdoses caused by non-injection drug use suggests a need for broader public health intervention that extend beyond the population injecting drugs. However, data on route of drug use is missing for over half of all overdose fatalities in North Carolina. More complete data on route of drug use will allow for more nuanced interpretation.

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A new national cohort analysis by Garel and colleagues quantifies what frontline physicians have long observed. Using high-dimensional propensity score matching on more than 137,000 patients with substance use disorders (SUD), the authors compared the cardiovascular impact of stimulant use disorder (StUD) with non-stimulant SUD. Their findings showed that individuals with StUD had a 37% higher risk of major adverse cardiac events (MACE), including myocardial infarction, stroke, heart failure, or death, as compared with patients with non-stimulant SUDs. Even after rigorous adjustment for demographic and clinical confounders, mortality remained 23% higher. These results demonstrate that stimulant use carries distinct and substantial cardiovascular risk, even within an already vulnerable population.

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12/09/2025

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Abstract
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