Understanding Regional Patterns of Overdose Deaths Related to Opioids and Psychostimulants

Abstract

Background

As overdose rates increase for multiple substances, policymakers need to identify geographic patterns of substance-specific deaths. In this study, we describe county-level opioid and psychostimulant overdose patterns and how they correlate with county-level social vulnerability measures.

Methods

A cross-sectional observational study, we used nationwide 2016-2018 restricted access Centers for Disease Prevention and Control county-level mortality files for 1,024 counties. We estimated quartiles of opioid and psychostimulant overdose mortality and provided estimates of their association with county-level Social Vulnerability Index (SVI) percentile.

Results

There was high opioid and psychostimulant overdose mortality in the Middle Atlantic, South Atlantic, East North Central, and Mountain regions. The Central US had the lowest opioid and psychostimulant overdose mortality rates. Counties with higher SVI scores (i.e. higher social vulnerability) were significantly more likely to experience high opioid and high psychostimulant overdose (high-high) mortality. A 10-percentile increase in SVI score was associated with a 3.1 percentage point increase in the likelihood of being a high-high county (p < 0.001) in unadjusted models and a 1.5 percentage point increase (p < 0.05) in models adjusting for region.

Conclusion

Our results illustrated the heterogenous geographic distribution of the growing concurrent opioid and psychostimulant overdose crisis. The substantial regional variation we identified highlights the need for local data to guide policymaking and treatment planning. The association of opioid-psychostimulant overdose mortality with social vulnerability demonstrates the critical need in impacted counties for tailored treatment that addresses the complex medical and social needs of people who use both opioids and psychostimulants.

Keywords:

• Opioids
• psychostimulant
• overdose mortality
• county mortality
• social vulnerability

Acknowledgments

We gratefully acknowledge the National Center for Health Statistics for the use of the vital statistics data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program.

Ethics approval

The study was approved by the Penn State University Institutional Review Board.

Declaration of interest

The authors declare that they have no conflict of interest. The authors alone are responsible for the content and writing of the article.

Additional information

Funding

Dr. Abenaa Jones was supported by grant K01 DA051715 from the National Institute on Drug Abuse. Dr. Noel Vest was supported by grants K01 DA053391 and L30 DA056944 from the National Institute on Drug Abuse.