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

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.