The Effect of Disasters and Social Vulnerability on Drug-Related Mortality in the U.S., 2000-2023

• In Event: 1 Substance Use, Misuse and Addiction: A Roundtables Session

Abstract

Drug-related morbidity, mortality, and dependence have increased exponentially in the U.S. over the past four decades. Over the same period, the occurrence of disasters and extreme weather events also increased. Moreover, more socially vulnerable communities and individuals experience disproportionate effects with regards to morbidity and mortality when disasters strike. Guided by a Big Events theoretical perspective, we examined the degree to which these two increasing trends, drug-related mortality and disasters, are related to identify how drug mortality may be exacerbated in communities that experience disasters. We also consider the degree to which community social vulnerability to disasters may affect this association. We used monthly death counts from 2000–2023 at the county level from the CDC’s restricted access mortality files, combined with a novel Federal Emergency Management Agency (FEMA) Disaster Declaration dataset that contains all officially declared disasters. We examined outcomes for drug overdose mortality and mortality from specific drug classes. We analyzed counts using negative binomial models that include a year fixed effect, a population exposure offset, and adjustments for repeated measures, and we consider separate models for both population-average effects and within-county fixed effects. For the latter, in a given county, compared to months with no disaster declaration, overall overdose deaths were 2.1% higher, with deaths 3.7%, 9.7%, and 4.7% higher for opioids, cocaine, and psychostimulants, respectively, in months with a disaster declaration (p<.001). Adjusting for county-level social vulnerability does not materially alter these associations, and interaction tests indicate that disaster effects vary by social vulnerability only for cocaine mortality. We find considerable evidence that disasters affect drug-related mortality. Thus, disasters appear to contribute to an escalation in drug-related mortality, and there is a need to enhance resources and support for people who use drugs when disasters occur.

Authors

• Taylor June, The Ohio State University

• Michael Vuolo, The Ohio State University

• Smitha Rao, Ohio State University

• Alan K Davis

• Brian Christopher Kelly, Indiana University-Bloomington