Highlights COVID-19 pandemic disrupted treatment service delivery and harm reduction. Individuals with opioid use disorder may be at heightened risk of opioid overdose. Emergency medical services (EMS) data is a timely source for overdose surveillance. Kentucky EMS opioid overdose runs increased significantly during COVID-19 period. In contrast, average EMS daily runs for other conditions leveled or declined.

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A comprehensive multisource DOFSS improved drug overdose fatality surveillance by increasing completeness of data and data quality. DOFSS is a model that can be considered by other states to enhance their efforts in tracking drug overdose fatalities, identifying new and emerging trends, and informing policies and best practices, to address and reduce drug overdoses.

In April 2020, early signals from emergency medical services data raised concerns for increasing numbers of drug overdoses during the emerging COVID-19 pandemic in Kentucky. 1 Subsequently, provisional national data for the 12-month period ending May 2020 showed accelerated drug overdose deaths, resulting in a Health Alert Network Advisory calling for expanded prevention efforts. 2 This cross-sectional study evaluates the changes in drug overdose mortality rates for Kentucky residents between 2019 and 2020. MethodsThis study was approved by the University of Kentucky institutional review board and followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline for cross-sectional studies. Informed consent was not required or possible because the study used secondary data for deceased individuals, in accordance with 45 CFR §46.We used Kentucky Office of Vital Statistics death certificate data (extracted February 8, 2021).Reported 2020 data are provisional, incomplete, and intended as an early warning. Drug overdose deaths (all intents) and drug involvement were identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision-coded underlying and multiple causes of death 3 or text search in the cause-of-death section (see the eAppendix in the Supplement). Crude rates 4 per 100 000 population, 95% CIs, rate ratios (RRs), and P values were calculated by demographic group (sex, age group, race/ethnicity, and metropolitan vs nonmetropolitan residency). 5 Classification by race/ethnicity was based on death certificate information and aimed to identify specific trends in racial/ethnic groups to inform targeted interventions. Statistical tests for significance of 2020 vs 2019 RRs by group were calculated in Poisson regression models with yeargroup interaction. All P values were from 2-sided tests and were considered significant at α = .05.Data were analyzed using SAS statistical software version 9.4 (SAS Institute). ResultsThere were 3225 Kentucky resident overdose deaths in 2019 to 2020; more than 60% were male (2154 residents), 90% were White non-Hispanic (2903 residents), and more than 25% of deaths (923 residents) occurred in the age group 35 to 44 years. There was a 45.06% increase in overdose deaths from 2019 (1316 deaths) to 2020 (1909 deaths). The 2020 crude overdose mortality rate was 42.64 deaths per 100 000 population (95% CI, 40.77-44.59 deaths per 100 000 population), which was significantly higher than that in 2019 (29.46 deaths per 100 000 population; 95% CI, 27.86-31.05 deaths per 100 000 population; P < .001) (Table ). Kentucky registered a record-high number of deaths in May 2020 (240 deaths) (Figure), a 150% increase from May 2019. Monthly overdose death counts in June to December 2020 remained elevated compared with the same months in any of the previous 9 years.Significant increases in mortality rates were observed for both sexes, Black non-Hispanic residents, White non-Hispanic residents, all age groups, a...