Abstract
Opioid overdose deaths are an important public health issue in the United States. Illegally manufactured fentanyl has spread widely and overlaps with stimulants, which makes overdoses more complex. Differences in overdose patterns exist based on region, sex, age, and race/ethnicity. The objective of this study was to examine regional, demographic, and substance-specific differences in opioid overdose deaths reported through the Centers for Disease Control and Prevention State Unintentional Drug Overdose Reporting System (SUDORS). A cross-sectional study was conducted with de-identified publicly available SUDORS data on deaths involving drug overdose in 27 jurisdictions from 2021-2023. Data were aggregated by Midwest, Northeast, South, and West regions. Comparisons were made between regions on death counts from opioid, opioid-stimulant combinations, opioid-benzodiazepine combinations, prescribed opioid, methamphetamine, heroin, cocaine, and illegally manufactured fentanyl. Race/ethnicity, age, and sex were also compared between regions. Statistical analysis was performed using descriptive statistics and chi-square tests. A p-value of <0.05 was considered statistically significant. Deaths involving any opioid (37,171), illegally manufactured fentanyl (33,701), cocaine (17,688), heroin (3,631), prescribed opioids (6,716), and opioid-benzodiazepine combinations (5,832) were highest in the Northeast. Opioid-stimulant combinations (23,698) and methamphetamine (12,697) were highest in the South. Males had more deaths than females in all regions. White individuals had the largest absolute counts in all regions, while Black and Hispanic individuals varied significantly by region. All reported regional comparisons were statistically significant (p<0.0001). The results suggest that the opioid overdose death rate varied based on location, type of opioid, and population demographics. This indicates that fentanyl played an important role in some areas, but the demographics and involvement of stimulants are not consistent across the United States. The study supports prevention strategies that reflect local drug supplies and population needs.