No explanation for gender difference
Brown University
Rhode Island has been
particularly affected: In December 2020, the state had the highest rate in the
country of COVID-19 cases and deaths relevant to population; during the first
eight months of 2020, the rate of unintentional drug overdose deaths in Rhode
Island increased 28% relative to the same period in the prior year.
Researchers at Brown
University’s School of Public Health wanted to learn more about the causes of
the overdoses during the pandemic, as well as the people affected by them, as
scant data were available. They analyzed two years of health data to look for
trends and patterns.
According to their
study, published on Friday, Sept. 17, in JAMA Network
Open, men, individuals who had lost jobs and people with mental
health diagnoses experienced the largest increases in rates of overdose deaths
during the pandemic. The researchers also found increases in deaths involving
synthetic opioids and in deaths occurring in personal residences (compared to a
hospital or elsewhere).
“Our motivation for this study was to understand more about the causes and characteristics of these overdose deaths and to identify some of the groups of people who are at heightened risk of overdose during the pandemic,” said Alexandria Macmadu, a study co-author and Ph.D. candidate in epidemiology at Brown.
The team analyzed
information from four statewide databases linked via the Rhode Island Data
Ecosystem. They compared the characteristics of 264 adults in the state who
died from an overdose during the first eight months of 2020 to those of 206
adults who died from an overdose during the same period in the year prior,
examining variables such as age, sex, race and ethnicity, as well as the type
of drug contributing to death, location of death and socioeconomic factors such
as housing insecurity, job loss and wages.
The findings show that overdoses increased significantly among males (who accounted for 72% of deaths in 2019 vs. 77% in 2020), people using synthetic opioids (71% vs. 76%) and occurring in personal residences (45% vs. 53%).
People experiencing job loss
represented a greater portion of overdose deaths (who accounted for 8% of
deaths in 2019 vs. 16% in 2020), and there was an increase in overdoses in
subgroups of people with mental health diagnoses.
The researchers
hypothesized that men and women would be affected by overdose deaths at the
same rates, said Brandon Marshall, study corresponding author and an associate
professor of epidemiology at Brown’s School of Public Health.
“To see the
significant increase in overdose deaths among men was surprising,” Marshall
said. “I don't think we have a good explanation for that at this time, and it’s
something that requires further research.”
The researchers note that differences between overdose deaths in 2020 compared to 2019 correspond to changes that occurred during the pandemic, including increased isolation, an onslaught of mental health stressors, widespread economic insecurity and the lethality of the drug supply.
The new findings provide guidance for clinicians,
public health officials, scientists, policymakers and others who hope to stem
the tide of overdose deaths, the researchers said.
As an example, they
cite the finding that a significant number of people were pronounced dead from
an overdose in their personal residence.
“We already know that
many people were socially and physically isolated during the early months of
the pandemic,” Marshall said. “Our findings show that, as a result of the
pandemic, a significant number of people are using drugs alone right now —
which means there’s no bystander available to intervene or call 911. This
greatly increases overdose risk.”
The researchers offer
a number of recommendations to address this risk, including the strengthening
of Good Samaritan law protections for those who call 911; state establishment
of pilot harm reduction centers to provide a safer, supervised environment for
drug use; and safely prioritizing in-person recovery services to enhance
support for socially isolated individuals at high risk of overdose.
These recommendations
for interventions to reduce overdose deaths will still be highly applicable to
a post-pandemic world, Macmadu said. In fact, some of the changes that have
been made in response to the pandemic, including audio-only telehealth
consultations to begin addiction treatment with buprenorphine, will be highly
beneficial even when the world opens up and returns to a new normal.
The authors said it’s
notable and timely that Rhode Island recently became the first state
to authorize overdose prevention sites, or “harm reduction centers”
— places where people can safely use drugs under medical supervision, and where
trained staff can connect them to evidence-based harm reduction strategies and
programs. Creating these sites is a step in the right direction in battling the
opioid epidemic, they said.
“Continued expansion
of access to evidence-based treatment and harm reduction programs for people
who use drugs will be critical in addressing the epidemic of overdose deaths,
during a viral pandemic as well as in the future,” Macmadu said.
Contributors to this
study included, among others, Kimberly Paull from the Rhode Island Executive
Office of Health and Human Services and Magdalena Cerdá, an associate
professor and director of the Center for Opioid Epidemiology and Policy at the
Department of Population Health at New York University’s Grossman School of
Medicine.
This research was
supported by the National Institute on Drug Abuse (F31DA052971 and
R01DA046620); the Center for Biomedical Research Excellence (COBRE) on Opioids
and Overdose, funded by the National Institute of General Medical Sciences
(P20GM125507); and an Institutional Development Award from the National
Institute of General Medical Sciences of the National Institutes of Health
(U54GM115677), which funds Advance Clinical
and Translational Research (Advance-CTR).