Increases in drug overdose deaths in Norway and the United States during the COVID-19 pandemic

Abstract

Introduction: Little international comparative work exists describing pandemic-related spikes in overdose and related implications for drug and public health policy. We compared increases in overdose deaths during the pandemic in Norway and the United States, two countries in the top 10 for per-capita overdose mortality, yet with very different approaches to the pandemic, healthcare and drug policy. Methods: We examined monthly overdoses in 2020 versus baseline rates (the monthly average across 2017–2019). We compared excess overdose mortality to shifts in human mobility and social interaction, measured using cellphone-based mobility data, an indicator of the societal response to the pandemic. Results: Both the US and Norway saw large magnitude exacerbations in overdose mortality during the pandemic-related lockdowns, reaching 46.8% and 57.0% above baseline, respectively. Maximum increases occurred 2–3 months after peak reductions in mobility, suggesting lagged mechanisms. While overdose mortality returned to baseline relatively quickly in Norway, rates remained elevated in the US to the end of 2020. Conclusions: Spikes in overdose mortality in both contexts may relate to disruptions in healthcare access and the drug supply becoming more potent. Norway’s quicker return to baseline may reflect more robust access to harm reduction and addiction-related healthcare services. Nevertheless, it is notable that even in Norway – with universal access to high-quality services, low COVID-19 rates, and a highly effective public health infrastructure – a greater than 50% spike in overdose deaths was still seen at the onset of lockdown measures. This may have important implications for future pandemic and disaster planning.

Effect of Risk Mitigation Guidance for opioid and stimulant dispensations on mortality and acute care visits during dual public health emergencies: retrospective cohort study

“…Unregulated drug poisoning (overdose) is a public health emergency in North America and internationally that worsened during the covid-19 pandemic. 1 2 Since March 2020, overdose related mortality has increased in Canada and the United States, where 7560 and 80 816 people respectively died of overdose in 2021. 3 4 5 Adulteration of the illegal drug supply with fentanyl is the leading contributor to overdose related deaths in Canada.…”

Incidence of SARS-CoV-2 and all-cause mortality in persons with co-occurring substance use disorder and mental illness during the pandemic: a Norwegian cohort study

“…The present study only includes all-cause mortality, being unable to identify drug-related deaths. Other studies, however, have found evidence of this increase [28], and persons with SUD/MI are reported to have consumed stronger substances than usual to cope with the pandemic [21]. With restricted access to syringe services, persons who inject drugs might have re-used or shared syringes, which could have caused infections.…”

Overdosevarslingssystemer – en kartleggingsoversikt med maskinlæring

“…Det er det høyeste antall overdoser registrert på 20 år. Overdoser økte kraftig i Norge under pandemien, antageligvis på grunn av sterkere heroin på markedet og begrenset tilgang til lavterskeltilbud, men tallene har nå stabilisert seg ( Friedman & Gjersing, 2022 ). De alle fleste overdosetilfeller i Norge skyldes opioider, hvorav illegal heroin er hovedårsaken (FHI, 2021).…”