STUMP » Articles » Drug Overdose Deaths, Part 3: Geographical Differences for 2019 and 2020 » 20 March 2022, 06:27

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Drug Overdose Deaths, Part 3: Geographical Differences for 2019 and 2020  


20 March 2022, 06:27

To close out the slice-and-dice on drug overdose trends, I am going to focus on the geographic spread in 2019 and 2020, and what changes occurred by state.

Top-level results:

1. Drug ODs have been worst along the Appalachian way, as it were, and the East Coast, with West Virginia being the worst state for drug OD deaths for quite some time. Even with that, West Virginia had a 57% increase in drug OD rate in 2020, which may have come down in 2021.

2. Percentage increases were also high in states with relatively low drug OD rates, such as California. California drug OD rates increased 50% in 2020.

3. While some states may have seen drug OD decreases in 2021 after increases in 2020, overall in the U.S., drug ODs continued to rise in 2021.

Baseline MVA death rates in 2019 — crude rate and age-adjusted rate

2019 crude rate of death by drug OD:

Age-adjusted death rate for 2019:

I am mainly graphing both of these for thoroughness, as they look pretty much the same. No, the numbers aren’t exactly the same, but the pattern is pretty much the same.

Note that we’ve got a swathe through the Appalachian Mountains, essentially, plus Delaware/DC. In the West, we’ve got a hot spot in New Mexico, and maybe it spreads out from there.

But in general, the activity seems to be centered around a band along the mountains. My assumption would be there are drug distribution routes through New Mexico and up some highway along through the East Coast (I-85 or I-95, perhaps) that spreads the drugs from their origin near the border, I’m assuming.

Because that’s what I’m assuming is happening. The drug ODs, once you dig into the data, are primarily fentanyl. Given the geographic spread, my assumption would be to check for a distribution route over land.

2020 distributions for drug OD death rates

So that we can compare to 2019, I’m using the same breakpoints for the color scale.

2020 crude rate of death by drug OD:

Age-adjusted death rate for 2020:

These maps have a similar pattern to 2019, just darker. “Just”. The entire East Coast looks pretty dark there.

But we are seeing more color out West, which is really going to have an effect when we look at percentage change, year-over-year. That’s when it is going to pop, because overall, drug ODs were up 35% on an age-adjusted basis, which is an incredible increase.

And we will see that increase was not even over the states.

Percentage change from 2019 to 2020

Get ready for some ugliness.

Percentage change for crude rate from 2019 to 2020:

Percentage change for age-adjusted rate from 2019 to 2020:

First, let me point out my breakpoints for this color scale: the darkest color represents an increase of over 50%.

That’s an amazing increase in mortality, whether measured on a crude or age-adjusted basis.

Some states with high drug OD death rates already had over 50% increases (we will see that in tables below).

The “lowest” bucket, to make this reasonable, are those with under a 20% increase. Most of those states with low increases had relatively high OD rates pre-pandemic.

In any case, some of those western states saw large increases in drug OD deaths. Nobody was safe from the increase in ODs.

Tables for largest states and for the states with the worst drug OD rates

Largest states:

I want to show how the large states did, just so you can see some of these numbers in context.

  • For the entire U.S., we had a 35% increase in drug ODs by rate, and we can see that California alone saw a 50% increase. Its drug OD rate, typical of western states, is relatively low. But it saw a jump up in its OD rate to something still below the national average.
  • Texas’s increase in drug ODs was similar to the national average, and its rate is well below the national average. I’m not sure exactly why, especially given we think the fentanyl driving the ODs are coming from Mexico. But perhaps it’s coming through Louisiana, and not Texas (more via next table).
  • Florida and New York are interesting — had similar increases, and Florida’s OD rate is higher than NY’s, but Florida is likely closer to the fentanyl source.
  • In this table, the states with the highest drug OD death rates are Pennsylvania & Ohio — “Rust Belt” states. Interestingly, both had below average increases in their death rates, but obviously still had much higher than average rates in 2020.

Worst rates:

  • West Virginia was worst-ranked in both 2019 and 2020. WV has long been the worst for drug overdoses, even before fentanyl came on the scene. Before fentanyl, we had oxycontin to blame. Even with one of the worst rates pre-pandemic, it managed to have an eye-popping 57% increase in its age-adjusted death rate. The number of drug overdose deaths they had in 2020 was truly horrific. The numbers were coming down in 2021, thank goodness:
  • These states are all along the eastern U.S., as we already could see from the maps above. (and yes, Washington, DC, isn’t a state, but whatever.) They do range in population, and interestingly there were lots of differences in increases in rates. Seven of these ten were in the top 10 in 2019, but the three that weren’t were in the top 20. It’s not like there were any great shockers.
  • I was not aware that Delaware was number 2 for drug ODs, but interestingly that the rate hadn’t gone up much in 2020. Maybe having the Secret Service there all the time in 2020, as Biden was campaigning from his house (and evidently still staying there most weekends now), has been keeping the rate in check, albeit at its already high rates. One could make a Hunter Biden joke, but I doubt Hunter lives in Delaware, and he hasn’t died yet.
  • Louisiana, being on the Gulf Coast, might be the state that’s the entry point for the Mexican-sourced fentanyl driving the East Coast trade in 2020, thus its high drug OD death rate, and Texas’s low rate. It had a very high increase in its death rate in 2020.

These numbers are simply awful, and for the United States overall, as I showed in prior posts, while it may have been going down for West Virginia as shown above, the 2021 numbers do not show happy trends:

The solid line is the actually-reported drug overdose deaths, and the circles are the trended amounts, as the CDC statisticians know about reporting lag. As I have mentioned many times before, it takes more time for cause of death determination for particular causes of death, accidental drug overdoses being one of them.

Looking at this graph, they have the 2021 trend at a lower slope, that is, growing at a slower rate, compared to the 2020 drug OD deaths. However, it’s still at a steeper trend than pre-pandemic trends.

Putting it all together

This is the last of the really nasty “external” causes of death, or non-natural causes of death that I’ve been looking at.

Here is the full list, with the links:


Suicide: Trends, 1968-2020, and Provisional Counts Through June 2021 – this one had only one standalone post, but I’m not done with this topic yet.

Mortality Nuggets: Videos on Suicide Rate Trends, Society of Actuaries Report, and Fixing Their Graph — there are a variety of mortality trends covered in video form here, and suicide rate trends are in the first video.


Homicide: Trends, 1968-2020, and Provisional Counts Through June 2021

The Geography of Homicide — States, Base Rates, Increases, and Correlations

Motor vehicle accidents

Motor Vehicle Accident Deaths: High-Level Trends, 1968-2020, Part 1

Motor Vehicle Accident Deaths, Part 2: Age-Related Trends with Provisional Results in 2021

Motor Vehicle Accident Deaths, Part 3: Geographical Differences, 2019 vs 2020

Drug overdose deaths

Drug Overdoses, Part 1: High-Level Trends, 1999-2020

Drug Overdose Deaths, Part 2: U.S. Age-Related Trends 1999-2020 with Provisional Results in 2021

Drug Overdose Deaths, Part 3: Geographical Differences for 2019 and 2020

As a reminder, I have a Mortality with Meep category, if you want to only look at mortality-related posts (I do write about other things, like public finance).

The next step I have is putting these pieces together — throughout this series, I have noted that these causes of death disproportionately affected teenagers and young adults.

And it has disproportionately affected them not only in relation to how COVID has killed them, but they have had a disproportionate increase in their mortality compared to all the other age groups, on an all-cause basis.

Yes, even when you throw in the effects of COVID on old people.

But that’s for a future post.

In the meantime, if you’d like to hear me discussing some of these issues in video with a few other people, you can check out this video podcast: on a CDC COVID Tracker that is evidently completely screwed up, even after it’s supposedly fixed.

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