Published on Sat Jul 31 2021

Emerging and Continuing Trends in Opioid Overdose Decedent Characteristics during COVID-19

Garcia, G.-G. P., Stringfellow, E., DiGennaro, C., Poellinger, N., Wood, J., Wakeman, S., Jalali, M. S.

Since COVID-19 erupted in the United States, little is known about how state-level opioid overdose trends and decedent characteristics have varied throughout the country. We find emerging increases in annual opioid-related overdose death rates in Alaska, Colorado, Indiana, Massachusetts, North Carolina, Rhode Island, Utah, and Wyoming. Decreased heroin-involved overdose deaths were emerging in Alaska (-49.5% [P=0.001]), and continuing in Colorado (-33.3%)

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Abstract

Background: Since COVID-19 erupted in the United States, little is known about how state-level opioid overdose trends and decedent characteristics have varied throughout the country. Objective: Investigate changes in annual overdose death rates, substances involved, and decedent demographics in opioid overdose deaths across nine states; assess whether 2019-2020 trends were emerging (i.e., change from 2019-2020 was non-existent from 2018-2019) or continuing (i.e., change from 2019-2020 existed from 2018-2019). Design: Cross-sectional study using vital statistics data to conduct a retrospective analysis comparing 2020 to 2019 and 2019 to 2018 across nine states. Setting: Alaska, Colorado, Connecticut, Indiana, Massachusetts, North Carolina, Rhode Island, Utah, and Wyoming. Participants: Opioid-related overdose deaths in 2018, 2019, and 2020. Measurements: Annual overdose death rate, proportion of overdose deaths involving specific substances, and decedent demographics (age, sex, race, and ethnicity). Results: We find emerging increases in annual opioid-related overdose death rates in Alaska (55.3% [P=0.020]), Colorado (80.2% [P<0.001]), Indiana (40.1% [P=0.038]), North Carolina (30.5% [P<0.001]), and Rhode Island (29.6% [P=0.011]). Decreased heroin-involved overdose deaths were emerging in Alaska (-49.5% [P=0.001]) and Indiana (-58.8% [P<0.001]), and continuing in Colorado (-33.3% [P<0.001]), Connecticut (-48.2% [P<0.001]), Massachusetts (39.9% [P<0.001]), and North Carolina (-34.8% [P<0.001]). Increases in synthetic opioid presence were emerging in Alaska (136.5% [P=0.019]) and Indiana (27.6% [P<0.001]), and continuing in Colorado (44.4% [P<0.001]), Connecticut (3.6% [P<0.05]), and North Carolina (14.6% [P<0.001]). We find emerging increases in the proportion of male decedents in Colorado (15.2% [P=0.008]) and Indiana (12.0% [P=0.013]). Limitations: Delays from state-specific death certification processes resulted in varying analysis periods across states. Conclusion: These findings highlight emerging changes in opioid overdose dynamics across different states, which can inform state-specific public health interventions.