SHADAC Staff and External Authors

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e shadac@umn.edu

During the Pandemic, Drug Overdoses Became the Third Leading Cause of Death for U.S. Adolescents

Authors

Colin Planalp, MPA, Senior Research Fellow at SHADAC

Tyler Winkelman, MD, MSc Co-Director, Health, Homelessness, and Criminal Justice Lab at Hennepin Healthcare Research Institute

Fatal overdoses involving fentanyl grew nearly 300% among adolescents

For roughly a quarter-century, U.S. drug overdoses have increased nearly every year. While this ongoing tragedy has surely harmed adolescents through the loss of parents and other loved ones, overdose deaths among U.S. adolescents remained relatively rare and changed little during most of the opioid crisis.

However, this changed when overdoses among adolescents began to increase during the COVID-19 pandemic. In this blog, we take a closer look at adolescent drug overdose deaths during the pandemic period, including examining specific substances that led to these deaths.

Drug Overdoses Third Leading Cause of Death in Adolescents in 2022

From 2019 to 2022, the rate of fatal drug overdoses among U.S. adolescents (age 13-17) more than doubled — increasing from 1.3 drug overdoses deaths per 100,000 adolescents to 3.2 drug overdose deaths per 100,000 adolescents. With that change, drug overdoses became the third leading cause of death among U.S. adolescents in 2022, following firearm injuries and transportation-related injuries (e.g., automobile collisions).

Figure 1. Top Causes of Death Among U.S. Adolescents, 2019-2022

Source: SHADAC analysis of NVSS mortality data
* Statistically significant increase in overdose rate at 95% level.

Description of Figure 1 found in alternative text.

Fentanyl and Related Synthetic Opioids Most Common Substances in Adolescent Overdoses

We also examined the specific substances most commonly involved in fatal overdoses to understand the key drivers of this large increase in deaths among adolescents.

Fentanyl and related synthetic opioids played the largest role in growing adolescent drug overdose death rates, increasing by 293% between 2019 and 2022. Stimulants also contributed to the growing death toll: Also between 2019 and 2022, fatal overdoses involving cocaine increased by 104% during, and fatal overdoses involving methamphetamine and similar “psychostimulants” increased by 87%. Each of those increases was statistically significant.

Among the most common categories of substances involved in fatal overdoses, only natural and semi-synthetic opioids [commonly referred to as prescription opioid painkillers (e.g., oxycodone, morphine)] held statistically steady, with no significant change.

Figure 2. Most Common Substances Attributed to Fatal Overdoses Among U.S. Adolescents, 2019-2022

Source: SHADAC analysis of NVSS mortality data
* Statistically significant increase in overdose rate at 95% level.

Description of Figure 2 found in alternative text.

Adolescent Drug Overdose Deaths Warrant Attention and Solutions

The pandemic era marked an inflection point in the overdose crisis for adolescents, with drug poisonings rising to become one of the top three causes of death — more deadly than cancer. Given this development, the U.S. public health and health care systems need to urgently adopt strategies to mitigate the harm.

Effective approaches to reduce the harm of substance use and overdose among adults may not work for adolescents, whose substance use profile may differ. Interventions should be tailored to ensure adolescents aren’t overlooked by responses designed for adults. For instance, proliferation of trafficked counterfeit prescription pills, often containing fentanyl, may pose a unique risk for adolescents, who are more likely to misuse prescription medications than heroin.¹

The U.S. cannot afford to neglect this new development in the opioid crisis, which is killing adolescents at a historic and growing rate.

Learn more about the Opioid Epidemic in the United States here. You can continue to learn about drug and alcohol use or child and adolescent health in some of the following SHADAC products:

• Blog - What Are Adverse Childhood Experiences (ACEs)? ACEs Definition, Data Challenges, and Resources
• Brief - Sobering Statistics: Acceleration of Alcohol-Attributable Deaths Across the United States During the COVID-19 Pandemic
• Blog - Children’s Health Insurance in 2023: Exploring Rising Uninsured Rates for Low-Income Children

Sobering Statistics: Acceleration of Alcohol-Attributable Deaths Across the United States During the COVID-19 Pandemic

 

Alcohol has long been one of the few legal mind-altering substances in the United States. While legal, messaging around its use – and misuse – has often been mixed. Moderate levels of drinking, such as a glass of wine or beer with dinner, were once recommended as a way to promote better heart health and to help control blood sugar and cholesterol levels.^1,2  

Lately, however, the public health sphere has become awakened to the fact that even a small amount of alcohol can lead to negative health consequences, increasing risks for a number of chronic diseases and different types of cancer.³ These risks are even more pronounced for women who, biologically, process alcohol differently than men, and face higher odds of developing chronic health conditions, disease, and even increased risk of death from alcohol-induced causes.^4,5

Using vital statistics data from the CDC’s WONDER system, a new brief from SHADAC researchers examines the concerning rise in alcohol-attributable deaths among women, which underscore larger patterns of growth seen across the U.S. We also examine differences in alcohol-attributable deaths between demographic groups, including by age, race and ethnicity, and geographic location during the COVID-19 pandemic period (2019-2022).

Key findings from our analysis of alcohol-attributable deaths during this time include:

• While men have traditionally seen high rates of alcohol-attributable deaths, women saw a 33% increase in alcohol-attributable deaths from 2019 to 2022 – an acceleration over the 28% growth in the rates of their male counterparts.

• Alcohol-attributable death rates for American Indian and Alaska native people, already at historic highs, surged by over 20 percentage points (from 54.0 deaths per 100,000 people in 2019 to 78.4 per 100,000 people in 2022) – well over the rate for the overall U.S. population (13.5 deaths per 100,000 people).

• Rates also increased for people living in non-metro (i.e., rural) areas during the pandemic, rising by 36% from 14.5 per 100,000 people in 2019 to 19.6 per 100,000 people in 2022.

Each of these individual trends make up an alarming larger pattern of accelerating alcohol-attributable death rates reaching all the way back to 2006, the year that the data for alcohol-attributable deaths first revealed any increase. While rates for years prior to 2006 remained generally stable, rates began steadily rising from 2006 onward, growing by nearly 30% from 7.4 alcohol-attributable deaths per 100,000 people to 10.4 per 100,000 people just prior to the COVID-19 pandemic in 2019. During the pandemic, this rate grew again by 30% from 10.4 deaths per 100,000 people to 13.5 death per 100,000 in 2022 in just three years – a worrying acceleration.

To learn more about alcohol-related deaths and our analysis of these trends, read the full brief, "Sobering Statistics: Acceleration of Alcohol-Attributable Deaths Across the United States During the COVID-19 Pandemic".

SHADAC has also built an interactive map that shows rates of alcohol-attributable deaths for the U.S. and the states from 2006 to 2022 for you to explore the data yourself. Start exploring below.

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Notes and Citations

1. Callahan, A. (2024, February 17). How Red Wine Lost Its Health Halo. The New York Times. https://www.nytimes.com/2024/02/17/well/eat/red-wine-heart-health.html

2. Richardson, C. (2023, February 10). Is beer healthy? How much should people drink? Medical News Today.  https://www.medicalnewstoday.com/articles/is-beer-healthy

3. National Cancer Institute. (2021, July 14). Alcohol and Cancer Risk. National Institutes of Health. https://www.cancer.gov/about-cancer/causes-prevention/risk/alcohol/alcohol-fact-sheet

4. Centers for Disease Control and Prevention (2024, September 19). Sex and Gender Considerations on Alcohol Use and Health. https://www.cdc.gov/alcohol/about-alcohol-use/alcohol-and-gender-considerations.html

5. Zhao, J., Stockwell, T., Naimi, T., Churchill, S., Clay, J., & Sherk, A. (2023, March 31). Association Between Daily Alcohol Intake and Risk of All-Cause Mortality: A Systematic Review and Meta-analyses. JAMA Network Open, 6(3), e236185. doi:10.1001/jamanetworkopen.2023.6185

Hest, Robert
Senior Research Fellow

p 612-624-5507
e hestx005@umn.edu

Changing Population Estimates: Implications for Data Users

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The National Center for Health Statistics (NCHS) at the Centers for Disease Control (CDC) recently changed the population estimates they use to calculate population-level rates in their National Vital Statistics System (NVSS), such as birth rates and mortality rates that are commonly accessed through tools such as CDC WONDER. These population estimates allow for the production of rates by providing a population denominator against which to compare the number of births or deaths.

Beginning with the 2021 data year, CDC transitioned from using "bridged-race" population estimates based on the race and ethnicity categories specified in the 1977 OMB Race and Ethnic Standards for Federal Statistics and Administrative Reporting to using "single-race" population estimates from the U.S. Census Bureau (“Census”) based on the race and Hispanic ethnicity categories specified in the 1997 OMB standards for the collection of data on race and ethnicity. The bridged-race estimates had been created to better align the population estimates from Census that used the 1997 OMB categories with the birth and death records from vital statistics systems that in many cases still used the 1977 OMB categories. This transition to the single-race population estimates appears to be precipitated by Census' recent improvement to their collection of race and ethnicity data beginning with Census 2020 data collection and continuing with subsequent years of the American Community Survey.

This move to single-race population estimates has several implications for data users:

• Statistics based on the single-race population estimates are only made available via CDC WONDER for data years 2018 forward, and statistics based on bridged-race population estimates are only available through data year 2020. Data users should not make comparisons between statistics based on bridged-race population estimates and statistics based on single-race population estimates. Further, because of changes made in 2020 to how Census measures race and ethnicity, caution should be used when comparing statistics by race and ethnicity from 2020 and later to data from 2019 and earlier.
   
• CDC WONDER has expanded the number of race and ethnicity categories available to data users. Previously, only five race categories and two Hispanic ethnicity categories were available. This has been expanded to up to 31 race categories and two Hispanic ethnicity categories.
   
• The single-race population estimates produced by Census suppress the number of persons less than five years of age at the county level to comply with Census' privacy policies. This prevents users from calculating age-adjusted rates at the county level or by level of urbanization using the single-race data, though crude rates can still be calculated at these levels of geography.

This change also affects SHADAC’s Suicide Deaths measure on State Health Compare. That measure’s Race and Ethnicity breakdown is now available in separate series for data years 1999–2020 and 2018–2021; estimates should not be compared between these series. Furthermore, SHADAC is unable to update the Metropolitan Status breakdown for this measure past data year 2020 due to the previously explained county-level suppressions.

Going forward, data users should keep changes in the denominator in mind when comparing annual estimates based on CDC vital statistics data. SHADAC strives to account for these types of considerations on State Health Compare by making clear when data years aren’t comparable and providing data users with relevant context around changes in methodology and data collection.

Planalp, Colin
Research Fellow

p 612-624-4850
e cplanalp@umn.edu

Pandemic drinking may exacerbate upward-trending alcohol deaths

Even before 2020, alcohol-involved deaths reached a modern record

Considering the well-deserved attention paid to the opioid crisis in recent years, few people might guess that rates of alcohol-involved deaths were as high as or higher than opioid overdose death rates in nearly half of states (Figure 1).¹ Like the opioid crisis, the trend in alcohol-involved deaths is also worsening, having grown by roughly 50 percent in just over a decade. All this was before the coronavirus crisis had even begun.

Figure 1. State alcohol death rates vs. opioid death rates, 2019

Now, evidence is accumulating that the pandemic precipitated dangerous changes in the way people consume alcohol in the United States. For instance, research has found increased alcohol sales since the crisis began, a finding illustrated by data showing that liquor taxes represented a rare instance of increased revenues for some states, such as Minnesota, during the COVID pandemic.^2,3 Other studies have found that U.S. adults report consuming more alcohol in order to deal with pandemic-related stress, and that they are drinking more frequently and engaging in more high-risk drinking behaviors, such as heavy drinking and binge drinking.^4,5,6

As we climb our way out of the immediate crisis, the U.S. will need to shift attention back to long-running public health threats. Beyond the obvious toll of the virus itself, another legacy of the pandemic may be the exacerbation of existing problems, including alcohol-related deaths and the opioid crisis. The opioid crisis was commonly recognized before 2020, but the upward trend in alcohol deaths was still occurring largely under the radar (Figure 2). But recent attention to risky pandemic-related alcohol consumption can sharpen our focus on this emerging concern.

Figure 2. U.S. alcohol-involved death rates, 2000-2019

With alcohol especially, the U.S. has a window of opportunity to intervene before many people’s pandemic-era risky drinking habits result in deaths, since the bulk of alcohol-involved deaths result from years of excessive drinking. In the coming years, it will be vital for states to monitor and study these issues and to consider doubling down on policy initiatives to curb the tide through efforts such as enhancing access to treatment of substance use disorder and by persuading and assisting people in recalibrating their alcohol consumption to healthier levels.