Abstract

Drug overdose deaths in the U.S. began to sharply surge in 2013, driven by illicitly manufactured synthetic opioids such as fentanyl, in what is regarded to constitute the third wave of the U.S. overdose mortality epidemic. By 2016, fentanyl overtook heroin as the most commonly used drug in overdose deaths in the U.S. The rapid rise in fatal drug overdoses accelerated during the COVID-19 pandemic, with drug overdose deaths increasing by 30% from 2019 to 2020 and topping 100,000 calendar year deaths for the first time in 2021. Here, we perform a spatiotemporal analysis to investigate and characterize the socioeconomic correlates of drug overdose deaths in the U.S. prior to and during the COVID-19 pandemic, analyzing annual county-level drug overdose death counts during the five year period prior to the pandemic (2015-2019) and the first two years of the COVID-19 pandemic (2020 and 2021) from the lower 48 U.S. states and D.C. Using the Bayesian paradigm for statistical inference, we specify a flexible Poisson regression model with a non-parametric global time trend and separable spatiotemporal random effects, using the Integrated Nested Laplace Approximation (INLA) to perform model fitting. We obtain credible intervals for the quantities of interest, discovering that certain socioeconomic factors are more strongly associated with fatal drug overdoses during the pandemic compared to the pre-pandemic period. In public health terms, our findings indicate that the COVID-19 public health crisis steepened the socioeconomic gradient associated with drug overdose deaths, exacerbating the overdose crisis given the large macroeconomic shifts caused by the pandemic. From the vantage point of public policy, strategies to ameliorate the drug overdose crisis should address upstream social and economic factors that can lead to drug use, addiction, and their potentially fatal downstream effects, whose effects may be intensified during public health crises.