Opioid-related mortality: Dynamic temporal and spatial trends by drug type and demographic subpopulations, Massachusetts, 2005–2021

• Published in: Drug and alcohol dependence 2023-05, Vol.246, p.109836-109836, Article 109836
• Main Authors: Stopka, Thomas J., Larochelle, Marc R., Li, Xiaona, Bernson, Dana, Li, Wenjun, Ackerson, Leland K., Bayly, Ric, Dammann, Olaf, Bauer, Cici
• Format: Article
• Language: English
• Subjects: Adult; Age Distribution; Analgesics, Opioid; Clusters; Demographic variations; Drug Overdose - epidemiology; Drug type; Fentanyl; Heatmaps; Humans; Male; Massachusetts; Massachusetts - epidemiology; Middle Aged; Opiate Overdose; Opioid overdose mortality; Trends
• ISSN: 0376-8716; 1879-0046
• DOI: 10.1016/j.drugalcdep.2023.109836

Fatal opioid-related overdoses (OOD) present significant public health challenges. Intuitive and replicable analytical approaches are needed to inform targeted public health responses. We obtained fatal OOD data for 2005–2021 from the Massachusetts Registry of Vital Records and Statistics. We conducted heatmap analyses to assess trends in fatal OOD rates per 100,000 residents, visualizing rates by death year and decedent age at one-year intervals, stratifying by race/ethnicity, sex, rurality, and involved substances. We calculated Getis-Ord Gi* statistics to identify spatial clusters of OOD rates. Among 20,774 fatal OODs, rates were higher among males, and highly variable by race/ethnicity, age group, and rurality. While fatal OOD rates increased in urban before rural communities, rates were higher in rural communities by 2018–2019. Stimulant-related fatal OODs were elevated in 2020 and 2021. Fatal OOD rates involving fentanyl and stimulants increased precipitously and simultaneously in the non-Hispanic Black population in 2020 and 2021, with a bimodal age distribution peaking among those in their 40s and 60s. Elevated rates among 30-to-60 year old Hispanic residents were largely tied to synthetic opioids from 2015 to 2021. Spatial clusters were detected for prescription opioids, heroin, and stimulants in western Massachusetts. For synthetic opioids, hotspots became more ubiquitous across the state from 2016 to 2021, intensifying in southeastern Massachusetts. Our novel approach uncovered new time varying and spatial patterns in fatal OOD rates not previously reported. Identified shifts in fatal OOD rates by sex, age, and race/ethnicity can inform location-specific field actions targeting subpopulations at disproportionally high risk. [Display omitted] •Fatal opioid-related overdoses (OOD) quintupled in Massachusetts between 2000 and 2021.•Novel temporal and spatial analytical approaches can inform targeted responses.•OOD rates were higher in rural vs. urban communities by 2018–2019.•Fentanyl and stimulant-related rates rose jointly in non-Hispanic Black residents.•Elevated rates impacted a broad age range of 30-to-60 year old Hispanic residents.