The Research Brief is a short summary of interesting academic work.
The big idea
The COVID-19 pandemic has intensified the opioid epidemic, according to our new research, which shows that opioid overdoses increased in Pennsylvania in 2020 compared to 2018 and 2019.
Yet general trends obscure critical local variations. In particular, 19 Pennsylvania counties saw statistically significant increases in opioid overdoses. The people living in those 19 counties are both socially and economically diverse, indicating that overdoses weren’t just getting worse for one group of people.
In our study, we analyzed age-adjusted rates of opioid-related overdose incidents reported by emergency services personnel at the county level in Pennsylvania from 2018 to 2020. This measure is based on the number of overdose incidents that EMS responded to during the study period. We also interviewed public health care providers to identify key factors influencing opioid abuse.
Opioid overdose is the leading cause of opioid overdose accidental death in Pennsylvania, according to the Centers for Disease Control and Prevention. From 2010 to 2019, the number of opioid-related deaths in Pennsylvania increased nearly fivefold, rising from 5 per 100,000 people to 23.7 per 100,000 people. In 2020 this has risen to 42.4 per 100,000 people.
In previous work, we have shown that the first four months of the COVID-19 pandemic saw an increase in opioid overdoses in Pennsylvania. Our latest study extended this analysis to 2020.
Why it matters
Since the early 1990s, the opioid epidemic has gone through several waves. First, there were high mortality rates caused by prescription opioids, especially among the white rural population. The epidemic then shifted to heroin use and spread to heroin use urban and non-Hispanic black populations. More recently, synthetic opioids such as fentanyl have become the leading cause of overdoses.
Overdoses increased in Pennsylvania at the start of the COVID-19 pandemic. This initial increase came at the same time as a mandatory stay-at-home order designed to curb the spread of the virus. While this order was a necessary response, it resulted in a range of social consequences, including job loss, mental illness, isolation, and reduced access to inpatient addiction treatment.
In our latest study, we examined long-term trends and spatial patterns for the opioid epidemic. Our study shows statistically significant county-level changes in age-adjusted rates of opioid-related overdose incidents before and after the onset of the COVID-19 pandemic. Some Pennsylvania counties saw significant increases in opioid overdoses, including some with small populations, while others saw significant decreases.
Health care providers agree that while opioid abuse has increased statewide, local conditions matter and directly impact the epidemic. As one healthcare provider told us in an interview: “There is a lot of variation between provinces. You can drive the line for 20 minutes and it almost seems like another state. I think the rates of use are similar, but you see different types of associated factors with substance use in these counties.
To understand social factors, we examined the differences in opioid overdose rates between men and women and between black and white people. Our research shows that overdose rates among men and women fell between 2018 and 2019, but increased in 2020. These trends also declined among black and white individuals from 2018 to 2019, but those groups also experienced a large increase from 2019 to 2020. One benefit of our research is that it shows that broader segments of the population are now affected by the opioid epidemic .
Our work shows that the stress associated with the COVID-19 pandemic has been overwhelming for many people, resulting in an increase in substance abuse or relapse. We believe there is an urgent need for research and policy attention to these factors, especially in states like Pennsylvania, which had high levels of drug use prior to the pandemic.
Future work could evaluate whether funds are effectively distributed to address the effects of social isolation and the social inequalities surrounding opioid abuse.