Over the past 21 years of opioid overdose deaths—from prescription drugs to heroin to synthetic and semisynthetic opioids such as fentanyl—geography has played a role in where opioid-involved overdose deaths have occurred, reports a new Northwestern Medicine study.
But the coming wave will not discriminate between rural and urban areas, the study findings suggest. Every type of county — from the most rural to the most urban — is predicted to see dramatic increases in deaths from opioid-involved overdoses. The reason opioid overdoses have reached historical highs comes from combining synthetic opioids with stimulants such as cocaine and methamphetamines, a lethal cocktail that is hard to reverse during an overdose, the study authors said.
“I'm sounding the alarm because, for the first time, there is a convergence and escalation of acceleration rates for every type of rural and urban county,” said corresponding author Lori Post, director of the Buehler Center for Health Policy and Economics at Northwestern University Feinberg School of Medicine. “Not only is the death rate from an opioid at an all-time high, but the acceleration of that death rate signals explosive exponential growth that is even larger than an already historic high.”
The study examined geographic trends in opioid-involved overdose deaths between 1999 and 2020 to determine if geography played a role in the three waves and the theorized fourth wave of America’s opioid crisis. The authors used data recorded in the Centers for Disease Control and Prevention’s WONDER database for 3,147 counties and county equivalents categorized on a six-point urbanicity scale (most urban to most rural).
Looking at acceleration rates by geography
While some researchers have looked at an acceleration rate from one year to the next, the authors said, to their knowledge, no one has examined acceleration rates of opioid-involved overdose death rates systematically by geography for every year.
Near the end of the available data from 2020, overdose deaths in rural areas were escalating faster than in urban areas, according to the study. A visualization of the data illustrates that between 2019 and 2020, rates of opioid-involved overdose deaths converged while escalating for the first time across six types of rural and urban counties, Post said.
"We have the highest escalation rate for the first time in America, and this fourth wave will be worse than it’s ever been before,” Post said. “It’s going to mean mass death.”