The Impact of COVID-19 on Opioid-Related Overdose Deaths in Texas

Abstract

Prior to the COVID-19 pandemic, the United States was facing an epidemic of opioid overdose deaths, clouding accurate inferences about the impact of the pandemic at the population level. We sought to determine the existence of increases in the trends of opioid-related overdose (ORO) deaths in the Greater Houston metropolitan area from January 2015 through December 2021, and to describe the social vulnerability present in the geographic location of these deaths. We merged records from the county medical examiner’s office with social vulnerability indexes (SVIs) for the region and present geospatial locations of the aggregated ORO deaths. Time series analyses were conducted to determine trends in the deaths, with a specific focus on the years 2019 to 2021. A total of 2660 deaths were included in the study and the mean (standard deviation, SD) age at death was 41.04 (13.60) years. Heroin and fentanyl were the most frequent opioids detected, present in 1153 (43.35%) and 1023 (38.46%) ORO deaths. We found that ORO deaths increased during the years 2019 to 2021 (p-value ≤ 0.001) when compared with 2015. Compared to the year 2019, ORO deaths increased for the years 2020 and 2021 (p-value ≤ 0.001). The geographic locations of ORO deaths were not associated with differences in the SVI. The COVID-19 pandemic had an impact on increasing ORO deaths in the metropolitan Houston area; however, identifying the determinants to guide targeted interventions in the areas of greatest need may require other factors, in addition to community-level social vulnerability parameters.

Emergence of fentanyl‐related deaths in Travis County, Texas and surrounding areas: A retrospective review of postmortem fentanyl‐related drug toxicities from 2020 to 2022

“…There was a 146% increase in the number of fentanyl‐related deaths from 2020 to 2021 in Travis County and surrounding areas (Table 2), consistent with CDC reports of opioid‐related deaths in Texas from 2019 to 2020 (148%) [43]. In contrast, opioid‐related deaths in the metropolitan Houston area rose from 365 in 2019, to 549 in 2020, and 687 in 2021; a 51% increase from 2019 to 2020, and a 25% increase from 2020 to 2021 [27].…”

“…The opioid epidemic continues to pose a significant threat to the public nationwide and globally. Since approximately 2015, significant increases in fentanyl-related fatalities have been reported nationwide [21,[26][27][28][29][30][31], but especially in the Northeast and Midwest regions of the US [21,29]. Only recently has more toxicological information been published on the emergence of fentanyl and significant increases in fentanyl-related deaths in the Western [21,28,31] and Southern [27,32,33] regions of the US.…”

“…It is possible that the spike in fentanyl deaths observed in 2020 was directly related to COVID‐19, as a Stay Home—Work Safe Order was first issued for Travis County on March 24, 2020 [40]. Similarly, significant increases in opioid‐related overdoses were noted months after shelter‐in‐place orders were issued for Chicago's Cook County [41], San Francisco [42], and the Greater Houston metropolitan area [27]. There was a 146% increase in the number of fentanyl‐related deaths from 2020 to 2021 in Travis County and surrounding areas (Table 2), consistent with CDC reports of opioid‐related deaths in Texas from 2019 to 2020 (148%) [43].…”

How Financial Beliefs and Behaviors Influence the Financial Health of Individuals Struggling with Opioid Use Disorder

“…In the United States, approximately 7.6 million individuals are currently living with opioid use disorder (OUD), with nearly 9 million reported cases of OUD in 2022 [2,3]. Notably, during the peak of the COVID-19 pandemic, sociodemographic factors and heightened financial stressors contributed to a surge in opioid-related fatalities across the nation [4]. The diagnosis of OUD relies on criteria outlined in the American Psychiatric Association Diagnostic and Statistical Manual, fifth edition [5].…”

The rise and rise of fentanyl in postmortem casework

“…The United States Government declared a public health emergency in 2017 as a result of the opioid epidemic and NYS initially saw a decline in opioid‐related overdose deaths in 2018 and 2019 [2]. However, in the months prior to the start of the COVID‐19 pandemic in March 2020, there was an increase in overdose deaths and in addition, the impact of the pandemic has been recognized as contributing to the further increase in opioid‐related overdose deaths [6]. As shelter‐in‐place orders were mandated to protect the health of citizens during the pandemic, the impact of isolation and resulting mental health stresses were even greater for those individuals with substance use disorders.…”