The Drug Overdose Epidemic in the U.S.-Mexico Border Region: Shifts, Progression, and Community Characteristics.

OBJECTIVE: Previous studies show the reach of the current drug overdose epidemic into the U.S.-Mexico border region, albeit with a unique border-specific wave pattern compared to national waves and a delayed onset of fentanyl involvement (Wave I: 2002-2011, Wave II: 2012-2016, and Wave III: since 2017). The objective of this study is to examine the community predictors and the progression of overdose deaths across the U.S-Mexico border-specific epidemic waves. METHOD: Descriptive epidemiological profile of border communities across the unfolding of the opioid epidemic, integrated data from the CDC-WONDER multiple causes of death data set, the CDC SVI, Uniform Crime Report, and the Behavioral Risk Factor Surveillance System. Using spatially adjusted Bayes rates by border-specific epidemic waves, we provide a descriptive profile of the spatial unfolding of the drug overdose epidemic. Negative binomial regression models assessed community predictors of overdose deaths across waves. RESULTS: Spatial analysis identified moderate to steep increases in drug overdose deaths over the three waves along the border. The impact and unfolding of the epidemic in the U.S.-Mexico border region were not uniform and affecting communities with differing severity and timing. Our study also finds support for social vulnerability and community violence as predictors of overdose deaths over the current wave of the epidemic. CONCLUSION: Findings suggest that more disadvantaged U.S.-Mexico border communities may encounter increasing rates of overdose death over the coming years. Interventions need to target not only the supply side but also the underlying social root causes for sustainable overdose prevention.

An Examination of Seasonal Trends in Delaware Drug Overdoses, 2016-2020.

Objective: To examine whether overdose deaths and related metrics-overdose calls for service to police and non-fatal overdose emergency department visits-in Delaware follow within-year (i.e., seasonal) patterns during the most recent years of the opioid epidemic (2016-2020). Methods: We begin by providing descriptive statistics on yearly trends in overdose metrics, followed by Analysis of Variance (ANOVA) to analyze whether seasonal variations have a significant impact on the patterns of Delaware's overdose metrics while controlling for annual variations. Results: We find yearly variations across the three overdose-related metrics, with overdose deaths reporting the only consistent increases per year. Within-year, or seasonal, variations show the spring months have the most consistent increases in overdose deaths and overdose calls for service across years we studied. Finally, we report significant differences for all overdose metrics across years and seasons. Conclusions: As in prior studies, we find significant variation in overdose-related metrics by season in Delaware. Policy Implications: These findings lend support to existing interventions in slowing yearly growth in overdose deaths. However, allocation of resources and interventions to specific times of the year-when overdoses are highest-may further reduce risks and harms.

Prescription Drug Histories among Drug Overdose Decedents in Delaware.

Background: The US opioid epidemic largely featured deaths from prescribed medications during Wave 1 (1990-2010), but its progression since then has resulted more so from deaths to illegal opioids-such as heroin (Wave 2 - 2010-2013) and fentanyl (Wave 3 - 2013-present). As deaths to illegally manufactured fentanyl have increased, attention to the role of prescribed opioids may be waning. However, the shifting nature of today's opioid epidemic demands we monitor how both legal and illegal drugs are involved in overdose deaths. Objectives: The purpose of our study is to investigate the prescription drug (Rx) records of overdose death decedents to illuminate the continued role of prescribed medications in Wave 3 deaths. Methods: We matched drug overdose death data and prescription drug monitoring data to investigate the prescription drug records (i.e. types of opioids and other medications) of Delaware, USA, decedents who died from a drug overdose death between January 1, 2013, and March 31, 2015 (27 months). Results: Fentanyl decedents differed significantly from other decedents in prescribed medications, including the amount and proximity of opioid and Rx fentanyl prescriptions before death. These relationships held while controlling for demographic characteristics and contributing health conditions. Conclusions: Our findings show a continued presence of Rx opioids in overdose deaths and that those dying from fentanyl had different Rx records than those who died from other drugs. Continued monitoring of Rx drugs, improved toxicology testing and greater data access for more research should follow to inform effective interventions.

Is the Gender Gap in Overdose Deaths (Still) Decreasing? An Examination of Opioid Deaths in Delaware, 2013-2017.

OBJECTIVE: Drug overdoses among men have historically outnumbered those among women by a large margin. Yet, U.S. research on the first wave of the opioid epidemic involving prescription opioids has found women to be at increased risk. The current study considers if the narrowing gender gap in overdose deaths, as observed during the first wave, has continued into the most recent third wave, dominated by synthetic opioid deaths. This requires consideration of interactions between gender, age, and type of drug implicated. METHOD: Drawing on 2013-2017 Delaware toxicology reports for a total of 890 overdose deaths involving opioids, we distinguished between four gender/age groups--women 15-44, women 45-64, men 15-44, and men 45-64--to calculate crude death rates, male-to-female death rate ratios, and younger-to-older death rate ratios by type of opioid. RESULTS: Opioid overdose death rates during the third wave increased among both men (+102%) and women (+46%), but the larger increase among men resulted in an increase in the male-to-female death rate ratio (from 1.9 to 2.6). This trend was driven by the growing contribution of fentanyl (from 16% to 76%) and heroin overdose deaths (from 27% to 50%) compared with other opioid overdose deaths, which disproportionately affected men and younger individuals. Higher male-to-female death rate ratios were observed among older, compared with younger, individuals. CONCLUSIONS: Overdose deaths seem to have returned to a historically familiar pattern of dominance by younger males. Our findings suggest the gender-age distribution in deaths to specific opioid types must be considered for effective intervention.

Understanding Geographic and Neighborhood Variations in Overdose Death Rates.

The current opioid epidemic continues to challenge us in new and potentially troubling ways. For example, research today finds more overdose deaths occurring in rural, rather than urban, geographic areas. Yet, studies have often ignored heterogeneities within these spaces and the neighborhood variations therein. Using geodemographic classification, we investigate neighborhood differences in overdose death rates by geographical areas to further understand where and among what groups the problem might be most concentrated. For deaths between 2013 and 2016, we find significant variation in rates among neighborhoods, defined by their socio-economic and demographic characteristics. For example, overdose death rates vary up to 13-fold among neighborhoods within geographic areas. Our results overall show that while the rural or urban classification of a geographic area is important in understanding the current overdose problem, a more segmented analysis by neighborhood's socio-economic and demographic makeup is also necessary.