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Diphenhydramine-involved Fatal and Nonfatal Drug Overdoses in Tennessee, 2019–2022

Bibliographic Data

ID21645041
AuthorsSarah Riley Saint (0000-0002-1419-7380, Tennessee Department of Health, corresponding author), Edward Richard Onyango (0000-0002-5315-9918, Tennessee Department of Health), Edward Onyango (Tennessee Department of Health), Jessica Korona-Bailey (0000-0002-0314-5171, Tennessee Department of Health), Joshua Jayasundara (Tennessee Department of Health), Kristi F Hall (0000-0002-2236-031X, Tennessee Department of Health), Kristi Hall (Tennessee Department of Health), Sutapa Mukhopadhyay (0009-0004-7712-4201, Tennessee Department of Health)
Year2024
Volume59
Issue4
Pages638-642
Publication date2024-03-20
Open AccessNo
TypeARTICLE
VenueSubstance Use & Misuse (JOURNAL)
Journal identifiersISSN: 1082-6084 • E-ISSN: 1532-2491
PublisherInforma UK Limited (PUBLISHER • GB)
DOI10.1080/10826084.2023.2280542
PMID38189325
OpenAlexW4390671494
LanguageEN
References cited8

BACKGROUND: Diphenhydramine (DPH), known as the brand name Benadryl, is an over-the-counter medication associated with accidental ingestion leading to nonfatal overdoses. Additionally, DPH has been used in tandem with illicit substances leading to fatal drug overdoses. OBJECTIVE: In response to DPH being seized with illicit drugs as an adulterant, as well as its growing intentional misuse, we sought to explore its recent involvement in fatal and nonfatal drug overdoses in the state of Tennessee. METHODS: We conducted a statewide cross-sectional study to determine the characteristics of DPH-involved fatal and nonfatal overdoses in Tennessee during 2019-2022 using data from the State Unintentional Drug Overdose Reporting System, the Electronic Surveillance System for the Early Notification of Community-based Epidemics, and the National Forensic Laboratory Information System Public Data Query System. Frequencies were generated to compare demographic characteristics, circumstances, and toxicology between fatal and nonfatal DPH-involved overdoses. RESULTS: We identified 143 suspected nonfatal DPH and 409 fatal DPH-involved overdoses in Tennessee from 2019 to 2022. Nonfatal overdoses remained consistent while fatal overdoses peaked in 2021. Most nonfatal overdoses were under 18 (63.4%), while most fatal overdoses were between 18 and 64 years of age (95.7%). For fatal overdoses, fentanyl was the most prevalent substance on toxicology followed by prescription opioids. CONCLUSION: Nonfatal overdoses remained consistent while fatal overdoses peaked in 2021 in Tennessee. Use of DPH among other illicit substances lends to evidence suggesting its use as an adulterant. Monitoring of DPH-involved fatal and nonfatal overdoses is critical to inform harm reduction initiatives

Diphenhydramine · Drug · Drug overdose · Medical emergency · Poison control · Forensic Toxicology and Drug Analysis · Medicine · Opioid Use Disorder Treatment · Poisoning and overdose treatments · Pharmacology

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