JMIR Publications

ABSTRACT

Background:

In the United States, both drug overdose mortality and injection-involved drug overdose mortality have increased nationally, but these trends have not been summarized at the state level.

Objective:

We aimed to estimate the annual number of injection-involved overdose deaths in each US state from 2000-2020.

Methods:

We utilized data from drug treatment admissions (Treatment Episodes Dataset, TEDS-A) and National Vital Statistics System to estimate state-specific percentages of reported drug overdose deaths that were injection-involved from 2000 to 2020. TEDS-A data on route of administration at treatment admission were used to calculate the percent injecting each drug type, by demographic group (race/ethnicity, sex, age group), year and state. We used the resulting probabilities to estimate the number of overdose deaths that were injection-involved.

Results:

There was large variation among states in the estimated injection-involved overdose death rate (median [range], 14.72 per 100,000 persons [5.45 – 31.77]). The national injection-involved overdose death rate increased by 323% (95% CI: 255% - 391%) from 2010 (3.78, 95%CI: 3.33 - 4.31) to 2020 (15.97 95% CI: 14.55 – 17.61). States in which the estimated injection-involved overdose death rate increased faster than the national average were disproportionately concentrated in the Northeast region.

Conclusions:

Although overdose mortality and injection-involved overdose mortality has increased dramatically across the country, these trends have been more pronounced in some regions. A better understanding of state-level trends in injection-involved mortality can inform the prioritization of public health strategies that aim to reduce overdose mortality and prevent downstream consequences of injection drug use.