Urban-Rural and Geographic Differences in Drug Overdose Deaths

In 2019, 70,360 overdose deaths occurred in the United States, an increase of 4.8% from 2018. Significant geographic shifts in deaths involving synthetic opioids and methamphetamine were observed. Overdose death rates vary by type of drug involved and urban-rural status, but analyses have primarily been limited to drugs and drug classes identified by ICD-10 codes.

This session will present data on unintentional and undetermined drug overdose deaths, obtained from death certificates and medical examiner/coroner reports, including post-mortem toxicology, which are reported to the Centers for Disease Control and Prevention's State Unintentional Drug Overdose Reporting System (SUDORS). Detailed postmortem toxicology results were examined from 2019 deaths captured in SUDORS that occurred in 19 states and the District of Columbia. Regional and urban-rural differences in drug overdose death rates were calculated by type of drug involved (i.e., listed as cause of death). The results were that in 2019, rates of illicitly manufactured fentanyl (IMF) and cocaine-involved overdose deaths were 16.8 and 7.6 per 100,000 population, respectively, in urban counties, and 10.6 and 4.0, respectively, in rural counties. For methamphetamine, overdose death rates were 4.5 and 7.7 in urban and rural counties, respectively. Regional variations were also present, with an IMF-involved overdose death rate of 27.4 in rural northeastern counties and a methamphetamine-involved overdose death rate of 9.8 in western urban counties.

Presenters will conclude that geographic analyses can help inform overdose prevention and intervention efforts for specific communities. They will discuss interventions tailored for drugs associated with the highest overdose mortality rates and those that address community-level factors related to treatment access that may help reduce overdose mortality in specific areas.