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2017 Annual Meeting

September 12–14, 2017

Aurora, Colorado

The links below contained detailed information for the upcoming 2017 Safe States Alliance Annual Meeting, taking place September 12-14, 2017 in Aurora, Colorado.

Please note:

Expanding the Scope of the NVDRS – American Indian Unintentional Drug Overdose Deaths

Thursday, September 14, 2017 at 8:00 AM–9:15 AM MDT
Conference Room 2
Learning Objectives
  1. Identify the significant racial disparities in the American Indian drug overdose mortality rate in Minnesota.
  2. Learn about potential misclassification of suicides, especially with the continued increase in drug overdose deaths.
  3. How to use the National Violent Death Reporting System to improve surveillance of suicide and drug overdose deaths.
Statement of Purpose

In 2015, the drug overdose mortality rate in Minnesota was 10.6 per 100,000 population: the sixth lowest rate in the U.S. However, in Minnesota, there are significant disparities in drug overdose mortality rates, particularly among American Indians (AI). To provide more detailed information regarding the risk factors and circumstances of AI drug overdose deaths, the decision was made to include 2015 AI drug overdose deaths in the Minnesota Violent Death Reporting System (MNVDRS).


Death certificates were used to identify unintentional AI drug overdose deaths with an ICD-10 underlying cause of death of X40-X44. These death certificates were then imported into the MNVDRS. Data were abstracted from medical examiner records, law enforcement reports, and medical records to provide information regarding the risk factors, circumstances, and precipitating events that occurred before an unintentional drug overdose. These data were then analyzed and summarized.


In 2015, 41 drug overdose deaths in AI were identified; 39 were classified as unintentional; all were abstracted into the MNVDRS. Among AI, heroin was the most frequent drug cited in overdose deaths (44% among AI vs. 20% of all drug overdose deaths statewide). Toxicology results provided detailed descriptions of substances found, with a majority of decedents of all populations having more than one positive drug test. The median age of death among AI was 34.5 years, and younger than the overall median age of 44 years (p=0.0002). A number of the AI unintentional poisoning deaths were notable with regards to the manner of death, as the risk factors and circumstances resembled suicides.

Conclusions & Significance to the Field

Drug overdose deaths among AI occur at more than four times the rate of the overall population in Minnesota; decedents are younger, and have a higher prevalence of heroin, as well as other substances. Because of the findings and community concerns of an underreporting of suicide in AI, we created a suicide probability index based on the presence of the suicide risk factors of prior suicide ideation, attempt(s), and evidence of undiagnosed depression. This index will be used to enable a better understanding of these deaths and inform prevention measures.


Nate Wright, MPH, Minnesota Department of Health

Nate Wright works at the Minnesota Department of Health in the Injury and Violence Prevention Section as part of the Applied Epidemiology Fellowship Program administered by the Council of State and Territorial Epidemiologists (CSTE) and funded through the Substance Abuse and Mental Health Services Administration (SAMHSA). His work primarily focuses on suicide and drug overdose, but those topics encompass and overlap considerably with other related public health matters in which he participates. Recently, he has worked collaboratively with Minnesota’s American Indian community to address the serious concern of drug overdose and identify potential misclassification of unintentional overdose deaths.


Melissa Heinen, BSN, MPH, Minnesota Department of Health
Mr Jon Roesler, MS, Minnesota Department of Health

Primary Contact

Nate Wright, MPH, Minnesota Department of Health