Yearly overdose deaths equal an ‘entire Vietnam war’ despite receding pandemic-era spike

Key takeaways:

• Most states had higher fatal drug overdoses in the 4 years between 2020 and 2023 vs. their 2019 rates.
• Relaxing after recent decreases in fatal drug overdoses “would be premature,” the researchers said.

The rates of fatal drug overdoses stayed higher than expected in most states from 2020 to 2023 compared with trajectories before 2020, a cross-sectional analysis in JAMA Network Open showed.

Several states experienced significant rises in such rates vs. their pre-COVID-19 pandemic patterns, whereas the findings suggest “that the decline in overdose deaths may simply be an effect of COVID-19 ending,” Keith Humphreys, PhD, the Esther Ting Memorial Professor at Stanford University, told Healio.

“We are still unfortunately on a longer term growth curve,” he said.

The results come after the United States experienced a 3.1% decrease in drug overdose deaths in the 12-month period ending in December 2023, marking the first reduction in half a decade.

Furthermore, the 14.5% decrease in these deaths in the 12 months preceding June 2024 “has raised hopes that the deadly dynamics of the crisis have fundamentally shifted,” Humphreys and Mathew V. Kiang, ScD, an assistant professor in the department of epidemiology and population health at Stanford University, wrote.

However, “this speculation would be more plausible if the decline occurred across the U.S. and was due to more than returning to pre-pandemic levels of growth,” they added.

The two researchers examined fatal drug poisoning data of 48 states and the District of Columbia from 1999 to 2023, taken from the CDC WONDER database, to determine the geographic distribution of reductions and whether the improvements had been “driven by more than the waning exacerbating outcomes” of the pandemic.

They reported that most states had higher than expected drug-related mortality rates for all 4 of the years (53%) or 3 of the 4 years (18%) between 2020 and 2023 vs. their pre-2020 trajectories.

Overall, 94% of states had higher drug-related mortality in the 4 years between 2020 and 2023 compared with rates observed in 2019. The exceptions to this finding included Delaware (2020), New Hampshire (2020) and New Jersey (2022, 2023).

Alabama, Alaska, California, Colorado, Oklahoma, Oregon, Texas, Washington and Wyoming all experienced rapidly increasing drug overdose deaths compared with trends seen before 2020, the researchers noted.

Most of these states are west of Mississippi and “may reflect a shifting illicit drug supply as new areas become saturated with illicitly manufactured synthetic opioids,” they wrote.

In comparison, Arizona, Florida, Louisiana and Tennessee experienced a rise in fatal drug overdoses in the early pandemic years before their rates appeared to decrease toward or below their pre-2020 levels following the pandemic.

The researchers acknowledged some study limitations, such as the use of provisional death data in recent years and possible differences in reporting over time.

Primary care providers should “not relax in their efforts to provide overdose rescue and addiction treatment medications to those in need because overdoses are still far too common,” Humphreys told Healio. He also advocated for close monitoring when new drugs, such as xylazine, enter into the opioid supply,

“Sadly, despite the drop, we will still lose more Americans to drug overdose this year than we did soldiers in the entire Vietnam war,” Humphreys said.