COVID-19 and the Drug Overdose Crisis: Uncovering the Deadliest Months in the United States, January‒July 2020

Abstract

Objectives. To determine the magnitude of increases in monthly drug-related overdose mortality during the COVID-19 pandemic in the United States. Methods. We leveraged provisional records from the Centers for Disease Control and Prevention provided as rolling 12-month sums, which are helpful for smoothing, yet may mask pandemic-related spikes in overdose mortality. We cross-referenced these rolling aggregates with previous monthly data to estimate monthly drug-related overdose mortality for January through July 2020. We quantified historical errors stemming from reporting delays and estimated empirically derived 95% prediction intervals (PIs). Results. We found that 9192 (95% PI = 8988, 9397) people died from drug overdose in May 2020-making it the deadliest month on record-representing a 57.7% (95% PI = 54.2%, 61.2%) increase over May 2019. Most states saw large-magnitude increases, with the highest in West Virginia, Kentucky, and Tennessee. We observed low concordance between rolling 12-month aggregates and monthly pandemic-related shocks. Conclusions. Unprecedented increases in overdose mortality occurred during the pandemic, highlighting the value of presenting monthly values alongside smoothed aggregates for detecting shocks. Public Health Implications. Drastic exacerbations of the US overdose crisis warrant renewed investments in overdose surveillance and prevention during the pandemic response and postpandemic recovery efforts.

FIGURE 1—

Monthly Overdose Deaths From January 2014 to July 2020: United States Note. Overdose deaths in the United States are shown by month, from January 2014 to July 2020. For values in 2020, 95% prediction intervals are shown, recovered using the algorithm described in this analysis. This figure reveals that May 2020 was the deadliest month for overdose death in the United States in recent history, elevated above May 2019 by about 60%.

FIGURE 2—

Monthly Overdose Deaths in May 2014 Through 2020: Selected US States Note. Deaths per million people in the month of May are shown for 2014 through 2020, for a subset of states with the highest total number of overdose deaths in 2020 (to avoid states with small numbers, where trends are less stable). For values in 2020, 95% prediction intervals are shown, recovered using the algorithm described in this analysis. This figure highlights large-magnitude increases in overdose deaths in May 2020 compared with previous years, for nearly all states assessed. Particularly large increases were seen in West Virginia, Kentucky, and Tennessee.