CDC Report Shows Troubling Opioid Overdose Trends

Holly Hedegaard, MD

A new report commissioned by the US Centers for Disease Control & Prevention (CDC) highlights a rise in drug overdoses over the last half a decade , particularly in urban areas.

A team, led by Holly Hedegaard, MD and Merianne Rose Spencer, MPH, both of the National Center for Health Statistics, Division of Analysis and Epidemiology, examined recent mortality data from the National Vital Statistics System (NVSS) to further illuminate urban-rural differences in drug overdose death rates for all drugs and by selected types of opioids and stimulants.

“From 1999 through 2019, the age-adjusted rate of drug overdose deaths increased in both urban and rural counties,” the authors wrote. “Rates were higher in urban counties than in rural counties from 1999 through 2003, similar from 2004 through 2006, higher in rural than in urban counties from 2007 through 2015, and higher in urban than in rural counties from 2016 through 2019. Urban–rural differences over time were also seen in the rates of drug overdose deaths involving specific types of drugs.”

Differences in Trends

Overall, the age-adjusted rate of drug overdose deaths in urban counties went from 6.4 per 100,000 people in 1999 to 22.0 per 100,000 individuals in 2019. For rural counties, the age-adjusted rate increased from 4.0 to 19.6 in the same time period.

Between 1999-2003 the rates were higher in urban counties, as well as between 2016-2019, with the remaining years the rates being higher in rural counties.

Going against recent trends were California, Connecticut, North Carolina, Vermont, and Virginia, where overdose rates were higher in rural counties than in urban counties.

Type of Opioid

The investigators also found urban and rural differences in trends based on overdose deaths caused by different types of opioids.

Age-adjusted rates of drug overdose deaths involving natural and semisynthetic opioids, which includes oxycodone, hydrocodone, and codeine were higher in rural than in urban counties from 2004-2017, while in 2018 and 2019, urban and rural rates were similar.

Between 1999-2019, the age-adjusted rates of drug overdose deaths from heroin were higher in urban counties, while the rate in urban counties was 4.6 in 2019 and 3.0 in rural counties.

For synthetic opioids other than methadone, which includes fentanyl, fentanyl analogs, and tramadol, the age-adjusted drug overdose death rates were higher in rural counties between 2001-2014.

However, this trend reversed in 2015, where the rates rose quicker in urban counties and in 2019 the rate in urban counties was 11.9, 1.4 times higher than the 8.3 rate in rural counties.

Type of Stimulant

The investigators also found differences in trends for overdose deaths by type of stimulant.

Between 2012-2019, , age-adjusted rates of drug overdose deaths involving psychostimulants with abuse potential, including methamphetamine, amphetamine, and methylphenidate) were higher in rural counties than in urban counties. In 2019, the rate was 6.7 in rural counties and 4.8 in urban counties.

The age-adjusted rates of drug overdose deaths involving cocaine was also higher in urban counties than in rural counties between 1999-2019. In 2019, the rate in urban counties (5.3) was more than twice the rate in rural counties (2.4).

The report, “Urban–Rural Differences in Drug Overdose Death Rates, 1999–2019,” was published online by the CDC.