{"id":"https://openalex.org/W7225162007","doi":"https://doi.org/10.1097/adm.0000000000001793","title":"How Should Stimulant Deaths Be Counted? A Cross-Sectional Analysis of Deaths Attributed to Opioids, Stimulants, or Alcohol","display_name":"How Should Stimulant Deaths Be Counted? A Cross-Sectional Analysis of Deaths Attributed to Opioids, Stimulants, or Alcohol","publication_year":2026,"publication_date":"2026-11-02","ids":{"openalex":"https://openalex.org/W7225162007","doi":"https://doi.org/10.1097/adm.0000000000001793","pmid":"https://pubmed.ncbi.nlm.nih.gov/42976232"},"language":"en","primary_location":{"id":"doi:10.1097/adm.0000000000001793","doi":"https://doi.org/10.1097/adm.0000000000001793","is_oa":false,"landing_page_url":"https://doi.org/10.1097/adm.0000000000001793","pdf_url":null,"source":{"id":"https://openalex.org/S107832660","display_name":"Journal of Addiction Medicine","issn_l":"1932-0620","issn":["1932-0620","1935-3227"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","dongbi-b","jufo-1","medline","norway-1","poland-70","russia-white-list-1"],"host_organization":"https://openalex.org/P4310315671","host_organization_name":"Lippincott Williams & Wilkins","host_organization_lineage":["https://openalex.org/P4310315671","https://openalex.org/P4310318547"],"host_organization_lineage_names":["Lippincott Williams & Wilkins","Wolters Kluwer"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Addiction Medicine","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref","pubmed"],"open_access":{"is_oa":false,"oa_status":"closed","oa_url":null,"any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5071421783","display_name":"Nora Anderson","orcid":"https://orcid.org/0009-0002-3048-8652","observed_orcids":["https://orcid.org/0009-0002-3048-8652"]},"institutions":[{"id":"https://openalex.org/I4210100173","display_name":"San Francisco Department of Public Health","ror":"https://ror.org/017ztfb41","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I4210100173"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Nora Anderson","raw_affiliation_strings":["San Francisco Department of Public Health, San Francisco, CA (NA, VMM, YSGC, POC)"],"raw_orcid":"https://orcid.org/0009-0002-3048-8652","affiliations":[{"raw_affiliation_string":"San Francisco Department of Public Health, San Francisco, CA (NA, VMM, YSGC, POC)","institution_ids":["https://openalex.org/I4210100173"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5052993024","display_name":"Vanessa McMahan","orcid":"https://orcid.org/0000-0003-2331-7206","observed_orcids":["https://orcid.org/0000-0003-2331-7206"]},"institutions":[{"id":"https://openalex.org/I4210100173","display_name":"San Francisco Department of Public Health","ror":"https://ror.org/017ztfb41","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I4210100173"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Vanessa M. McMahan","raw_affiliation_strings":["San Francisco Department of Public Health, San Francisco, CA (NA, VMM, YSGC, POC)"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"San Francisco Department of Public Health, San Francisco, CA (NA, VMM, YSGC, POC)","institution_ids":["https://openalex.org/I4210100173"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5011066962","display_name":"Yi-Shin Grace Chang","orcid":"https://orcid.org/0009-0008-3163-0343","observed_orcids":["https://orcid.org/0009-0008-3163-0343"]},"institutions":[{"id":"https://openalex.org/I4210100173","display_name":"San Francisco Department of Public Health","ror":"https://ror.org/017ztfb41","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I4210100173"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Yi-Shin G. Chang","raw_affiliation_strings":["San Francisco Department of Public Health, San Francisco, CA (NA, VMM, YSGC, POC)"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"San Francisco Department of Public Health, San Francisco, CA (NA, VMM, YSGC, POC)","institution_ids":["https://openalex.org/I4210100173"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5083704735","display_name":"Luke N. Rodda","orcid":"https://orcid.org/0000-0001-8660-6481","observed_orcids":["https://orcid.org/0000-0001-8660-6481"]},"institutions":[{"id":"https://openalex.org/I180670191","display_name":"University of California, San Francisco","ror":"https://ror.org/043mz5j54","country_code":"US","type":"education","lineage":["https://openalex.org/I180670191"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Luke N. Rodda","raw_affiliation_strings":["Office of the Chief Medical Examiner, San Francisco, CA (LNR)","University of California San Francisco, San Francisco, CA (LNR, POC)"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Office of the Chief Medical Examiner, San Francisco, CA (LNR)","institution_ids":[]},{"raw_affiliation_string":"University of California San Francisco, San Francisco, CA (LNR, POC)","institution_ids":["https://openalex.org/I180670191"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5002039390","display_name":"Alex H. Kral","orcid":"https://orcid.org/0000-0002-9092-3671","observed_orcids":["https://orcid.org/0000-0002-9092-3671"]},"institutions":[{"id":"https://openalex.org/I180297670","display_name":"RTI International","ror":"https://ror.org/052tfza37","country_code":"US","type":"nonprofit","lineage":["https://openalex.org/I137902535","https://openalex.org/I170897317","https://openalex.org/I180297670"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Alex H. Kral","raw_affiliation_strings":["RTI International, San Francisco, CA (AHK)"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"RTI International, San Francisco, CA (AHK)","institution_ids":["https://openalex.org/I180297670"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5048017362","display_name":"Phillip Oliver Coffin","orcid":"https://orcid.org/0000-0002-3891-6570","observed_orcids":["https://orcid.org/0000-0002-3891-6570"]},"institutions":[{"id":"https://openalex.org/I180670191","display_name":"University of California, San Francisco","ror":"https://ror.org/043mz5j54","country_code":"US","type":"education","lineage":["https://openalex.org/I180670191"]},{"id":"https://openalex.org/I4210100173","display_name":"San Francisco Department of Public Health","ror":"https://ror.org/017ztfb41","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I4210100173"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Phillip O. Coffin","raw_affiliation_strings":["San Francisco Department of Public Health, San Francisco, CA (NA, VMM, YSGC, POC)","University of California San Francisco, San Francisco, CA (LNR, POC)"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"San Francisco Department of Public Health, San Francisco, CA (NA, VMM, YSGC, POC)","institution_ids":["https://openalex.org/I4210100173"]},{"raw_affiliation_string":"University of California San Francisco, San Francisco, CA (LNR, POC)","institution_ids":["https://openalex.org/I180670191"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":3,"corresponding_author_ids":[],"corresponding_institution_ids":[],"apc_list":null,"apc_paid":null,"fwci":0.0,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":{"value":0.87690681,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10576","display_name":"Opioid Use Disorder Treatment","score":0.9063000082969666,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10576","display_name":"Opioid Use Disorder Treatment","score":0.9063000082969666,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10043","display_name":"Substance Abuse Treatment and Outcomes","score":0.07980000227689743,"subfield":{"id":"https://openalex.org/subfields/2713","display_name":"Epidemiology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11860","display_name":"HIV, Drug Use, Sexual Risk","score":0.005200000014156103,"subfield":{"id":"https://openalex.org/subfields/2713","display_name":"Epidemiology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/cocaine","display_name":"cocaine","score":0.5580000281333923},{"id":"https://openalex.org/keywords/psychostimulants","display_name":"psychostimulants","score":0.9810000061988831},{"id":"https://openalex.org/keywords/alcohol-related-mortality","display_name":"alcohol-related mortality","score":0.8349999785423279},{"id":"https://openalex.org/keywords/comorbidity","display_name":"comorbidities","score":0.777999997138977},{"id":"https://openalex.org/keywords/cardiovascular-comorbidity","display_name":"cardiovascular comorbidity","score":0.8029999732971191},{"id":"https://openalex.org/keywords/age-at-death","display_name":"age at death","score":0.7580000162124634}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.929099977016449},{"id":"https://openalex.org/C2780557958","wikidata":"https://www.wikidata.org/wiki/Q211036","display_name":"Stimulant","level":2,"score":0.8787000179290771},{"id":"https://openalex.org/C73269764","wikidata":"https://www.wikidata.org/wiki/Q954529","display_name":"Poisson regression","level":3,"score":0.6668000221252441},{"id":"https://openalex.org/C2781066024","wikidata":"https://www.wikidata.org/wiki/Q156","display_name":"Alcohol","level":2,"score":0.5099999904632568},{"id":"https://openalex.org/C2781063702","wikidata":"https://www.wikidata.org/wiki/Q427523","display_name":"Opioid","level":3,"score":0.5001000165939331},{"id":"https://openalex.org/C27415008","wikidata":"https://www.wikidata.org/wiki/Q7256382","display_name":"Psychological intervention","level":2,"score":0.49219998717308044},{"id":"https://openalex.org/C99454951","wikidata":"https://www.wikidata.org/wiki/Q932068","display_name":"Environmental health","level":1,"score":0.46950000524520874},{"id":"https://openalex.org/C190385971","wikidata":"https://www.wikidata.org/wiki/Q373494","display_name":"Injury prevention","level":3,"score":0.4429999887943268},{"id":"https://openalex.org/C107130276","wikidata":"https://www.wikidata.org/wiki/Q133805","display_name":"Epidemiology","level":2,"score":0.40369999408721924},{"id":"https://openalex.org/C149923435","wikidata":"https://www.wikidata.org/wiki/Q37732","display_name":"Demography","level":1,"score":0.39809998869895935},{"id":"https://openalex.org/C48856860","wikidata":"https://www.wikidata.org/wiki/Q12029","display_name":"Addiction","level":2,"score":0.3971000015735626},{"id":"https://openalex.org/C2780035454","wikidata":"https://www.wikidata.org/wiki/Q8386","display_name":"Drug","level":2,"score":0.3910999894142151},{"id":"https://openalex.org/C3017944768","wikidata":"https://www.wikidata.org/wiki/Q1450463","display_name":"Poison control","level":2,"score":0.3874000012874603},{"id":"https://openalex.org/C187155963","wikidata":"https://www.wikidata.org/wiki/Q629029","display_name":"Occupational safety and health","level":2,"score":0.36090001463890076},{"id":"https://openalex.org/C2909816603","wikidata":"https://www.wikidata.org/wiki/Q1639178","display_name":"Opioid-Related Disorders","level":5,"score":0.3587999939918518},{"id":"https://openalex.org/C526869908","wikidata":"https://www.wikidata.org/wiki/Q3298118","display_name":"Suicide prevention","level":3,"score":0.3409000039100647},{"id":"https://openalex.org/C40010229","wikidata":"https://www.wikidata.org/wiki/Q3184856","display_name":"Substance abuse","level":2,"score":0.3212999999523163},{"id":"https://openalex.org/C205545832","wikidata":"https://www.wikidata.org/wiki/Q17156455","display_name":"Young adult","level":2,"score":0.3098999857902527},{"id":"https://openalex.org/C138816342","wikidata":"https://www.wikidata.org/wiki/Q189603","display_name":"Public health","level":2,"score":0.30970001220703125},{"id":"https://openalex.org/C166735990","wikidata":"https://www.wikidata.org/wiki/Q1750812","display_name":"Human factors and ergonomics","level":3,"score":0.2937999963760376},{"id":"https://openalex.org/C118552586","wikidata":"https://www.wikidata.org/wiki/Q7867","display_name":"Psychiatry","level":1,"score":0.2906999886035919},{"id":"https://openalex.org/C2778903686","wikidata":"https://www.wikidata.org/wiki/Q60168","display_name":"Heroin","level":3,"score":0.2856999933719635},{"id":"https://openalex.org/C2777170798","wikidata":"https://www.wikidata.org/wiki/Q65087481","display_name":"Opioid epidemic","level":4,"score":0.2750999927520752},{"id":"https://openalex.org/C151956035","wikidata":"https://www.wikidata.org/wiki/Q1132755","display_name":"Logistic regression","level":2,"score":0.26899999380111694},{"id":"https://openalex.org/C61511704","wikidata":"https://www.wikidata.org/wiki/Q1671857","display_name":"Incidence (geometry)","level":2,"score":0.266400009393692},{"id":"https://openalex.org/C2994107952","wikidata":"https://www.wikidata.org/wiki/Q1814351","display_name":"Public health interventions","level":3,"score":0.2651999890804291},{"id":"https://openalex.org/C29374701","wikidata":"https://www.wikidata.org/wiki/Q1931388","display_name":"Cause of death","level":3,"score":0.26510000228881836},{"id":"https://openalex.org/C2776315796","wikidata":"https://www.wikidata.org/wiki/Q3505252","display_name":"Drug overdose","level":3,"score":0.26499998569488525},{"id":"https://openalex.org/C142052008","wikidata":"https://www.wikidata.org/wiki/Q954027","display_name":"Cross-sectional study","level":2,"score":0.2590999901294708},{"id":"https://openalex.org/C186079640","wikidata":"https://www.wikidata.org/wiki/Q719602","display_name":"Prevalence","level":3,"score":0.2572000026702881}],"mesh":[],"locations_count":2,"locations":[{"id":"doi:10.1097/adm.0000000000001793","doi":"https://doi.org/10.1097/adm.0000000000001793","is_oa":false,"landing_page_url":"https://doi.org/10.1097/adm.0000000000001793","pdf_url":null,"source":{"id":"https://openalex.org/S107832660","display_name":"Journal of Addiction Medicine","issn_l":"1932-0620","issn":["1932-0620","1935-3227"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","dongbi-b","jufo-1","medline","norway-1","poland-70","russia-white-list-1"],"host_organization":"https://openalex.org/P4310315671","host_organization_name":"Lippincott Williams & Wilkins","host_organization_lineage":["https://openalex.org/P4310315671","https://openalex.org/P4310318547"],"host_organization_lineage_names":["Lippincott Williams & Wilkins","Wolters Kluwer"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Addiction Medicine","raw_type":"journal-article"},{"id":"pmid:42976232","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/42976232","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of addiction medicine","raw_type":"Journal Article"}],"best_oa_location":null,"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","display_name":"Good health and well-being","score":1.0}],"study_designs":[{"id":"https://openalex.org/study-designs/observational-study","display_name":"Observational Study"}],"awards":[],"funders":[],"has_content":{"pdf":false,"grobid_xml":false},"content_urls":null,"referenced_works_count":30,"referenced_works":["https://openalex.org/W1972712963","https://openalex.org/W2012661449","https://openalex.org/W2056425055","https://openalex.org/W2060746497","https://openalex.org/W2074881763","https://openalex.org/W2081752817","https://openalex.org/W2164593389","https://openalex.org/W2510608890","https://openalex.org/W2688447374","https://openalex.org/W2741060213","https://openalex.org/W2793618010","https://openalex.org/W2948074701","https://openalex.org/W2951594704","https://openalex.org/W2963028828","https://openalex.org/W2969628213","https://openalex.org/W3005454586","https://openalex.org/W3201146081","https://openalex.org/W3204359040","https://openalex.org/W3210961082","https://openalex.org/W4214904076","https://openalex.org/W4234630005","https://openalex.org/W4283071186","https://openalex.org/W4285726068","https://openalex.org/W4307021568","https://openalex.org/W4389084983","https://openalex.org/W4409920450","https://openalex.org/W4409963255","https://openalex.org/W4413775459","https://openalex.org/W4414296635","https://openalex.org/W7134183200"],"related_works":["https://openalex.org/W4415779959","https://openalex.org/W2793618010","https://openalex.org/W7125122727","https://openalex.org/W4414296635","https://openalex.org/W4391594919","https://openalex.org/W4414845539","https://openalex.org/W7128487339","https://openalex.org/W4410978720","https://openalex.org/W4396888205","https://openalex.org/W4308188106"],"abstract_inverted_index":{"INTRODUCTION:":[0],"The":[1,107],"different":[2,117],"ways":[3],"deaths":[4,43,128,146,158,173,186,210],"are":[5],"counted":[6],"for":[7,15,21,81,86,103],"surveillance-all":[8],"attributable":[9,199],"to":[10,33,50,67,97,124,167,194,213],"alcohol":[11,145,157,172],"versus":[12],"acute":[13],"toxicity":[14],"opioids":[16,188],"or":[17,77],"stimulants-have":[18],"profound":[19],"implications":[20],"understanding":[22,207],"mortality":[23],"and":[24,79,89,156,171,184,211],"deploying":[25],"prevention":[26],"interventions.":[27],"OBJECTIVES:":[28],"To":[29],"explore":[30],"alternative":[31],"strategies":[32],"count":[34],"stimulant":[35,125,168,200,218],"(cocaine,":[36],"psychostimulants)":[37],"deaths.":[38,169,180,196],"METHODS:":[39],"We":[40,62,91],"grouped":[41],"substance-attributable":[42,119],"in":[44],"San":[45],"Francisco,":[46],"CA,":[47],"from":[48],"2015":[49],"2024":[51],"into":[52],"mutually":[53],"exclusive":[54],"categories":[55,121],"by":[56],"involved":[57],"substance":[58],"(opioids,":[59],"stimulants,":[60],"alcohol).":[61],"used":[63,93],"multivariable":[64],"Poisson":[65],"regression":[66],"determine":[68],"prevalence":[69,101,109,132,137,149,162],"ratios":[70,138],"of":[71,111,133,163,208,217],"additional":[72,113,134],"contributing":[73],"conditions":[74,114,135,165,192],"(any,":[75],"cardiac/hypertensive,":[76],"hepatobiliary":[78],"pancreatic)":[80],"each":[82,104],"drug":[83],"category,":[84],"adjusted":[85,99,108],"age,":[87],"sex,":[88],"race/ethnicity.":[90],"then":[92],"a":[94,160],"postestimation":[95],"technique":[96],"calculate":[98],"predicted":[100],"rates":[102],"group.":[105],"RESULTS:":[106],"ratio":[110],"any":[112],"was":[115],"significantly":[116,130],"across":[118],"death":[120],"(P<0.001).":[122],"Compared":[123],"deaths,":[126,201],"opioid":[127,179,195],"had":[129,147,159],"lower":[131,161],"[adjusted":[136],"(aPR):":[139],"0.51,":[140],"95%":[141,152],"CI:":[142,153],"0.48-0.55],":[143],"while":[144],"higher":[148],"(aPR:":[150],"1.24,":[151],"1.18-1.30).":[154],"Opioid":[155],"cardiovascular":[164],"compared":[166,193],"Stimulant":[170],"occurred":[174],"at":[175],"older":[176],"ages":[177],"than":[178],"CONCLUSIONS:":[181],"More":[182],"stimulant-":[183],"alcohol-attributable":[185],"without":[187],"include":[189],"complex":[190],"medical":[191],"Counting":[197],"all":[198],"excluding":[202],"opioids,":[203],"may":[204],"improve":[205],"our":[206],"these":[209],"interventions":[212],"address":[214],"health":[215],"consequences":[216],"use.":[219]},"counts_by_year":[],"updated_date":"2026-11-05T12:25:35.769452","created_date":"2026-11-04T00:00:00"}