A Look at One State’s Pandemic Overdose Deaths Shows Those Most at Risk

In Rhode Island, the number of overdose deaths jumped significantly in the first 8 months of 2020, a retrospective, population-based cohort study found.

Overdose deaths were found to have increased particularly among those experiencing job loss and among those diagnosed with certain mental health problems, providing insight into how overdose death rates have impacted populations since the start of the pandemic, said Brandon Marshall, PhD, of Brown University’s School of Public Health in Providence, and colleagues.

Using four statewide databases accessed via the Rhode Island Data Ecosystem, the researchers identified 470 adults who died due to a drug overdose between Jan. 1-Aug. 31, 2019 and Jan. 1-Aug. 31, 2020, 75% of whom were men, with an average age of 43.5.

As shown in the team’s study online in JAMA Network Open, the death rate in these cases rose 28.1% overall from 29.2 per 100,000 person-years in 2019 to 37.4 per 100,000 person-years in 2020 (P=0.009).

Policy recommendations that may help to alleviate the frequency of overdose deaths, the researchers said, include expanding access to medications for opioid use disorder, strengthening Good Samaritan law protections, and providing trauma-informed mental health services as part of treatment of substance use disorder.

Marshall and co-authors found that deaths involving synthetic opioids increased from 20.8 per 100,000 person-years in 2019 to 28.3 per 100,000 person-years (P=0.005); those that occurred in personal residences rose by 6.5% over the 1-year period (13.2 vs 19.7 per 100,000 person-years, P=0.003). There was also an increase in overdose deaths among individuals dealing with job loss (8% vs 16%, P=0.01).

The proportion of deaths involving heroin use, however, decreased between the two time periods (5% vs <2%, P=0.02).

For Medicaid beneficiaries who died from an overdose, Marshall and colleagues were able to discern certain trends among those who received prior mental health diagnoses. For example, overdose deaths increased among Medicaid recipients ages 50-59 diagnosed with anxiety (9% vs 19%, P=0.03); men with a depression diagnosis (22% vs 38%, P=0.008); and men with clinical anxiety (23% vs 37%, P=0.02).

As the researchers explained, long-term data about this evolving “syndemic” — i.e., the cluster of multiple epidemics — remains insufficient, but Rhode Island has been hit especially hard. In December 2020, the state reportedly had the highest rate of COVID-19 cases and deaths per 100,000 people in the country. Simultaneously, “preliminary data indicate that the rate of these deaths from overdose in the state in 2020 reached an all-time high,” the investigators noted.

The pattern of increasing overdose deaths falls in line with the hypotheses the investigators made about the impact the pandemic would have on drug use: i.e, that the combination of social distancing, isolation, and stay-at-home orders accompanied by financial stress, feelings of despair, and diminished access to treatment would exacerbate the already significant problem. The fact that most overdose deaths happened in personal residences (53%), the researchers said, supports these hypotheses.

In addition, Marshall and co-authors noted, the prevalence of fentanyl and other synthetic opioids in the number of overdose deaths, looked at in tandem with the decrease in heroin overdose deaths, points to an increasing lethality in the available drug supply — a trend consistent with national data.

The study’s small sample size was a limitation to the generalizability outside of Rhode Island, the authors acknowledged. The limited 16-month time span covered by the study posed another limitation, as trends in overdose deaths are subject to year-to-year changes.