I’m going to put the very ugly stuff up front, so you can look at the details below if you want.

From the prior post, I mentioned that drug overdose death rates were increasing before the pandemic already, first at an annual growth rate of about 7.7% per year increase over 1999 – 2014, and then 9.6% per year from 2014 to 2019.

Those are growth rates for the death rates themselves, not in the number of deaths. You can’t simply blame this on population growth. Not that the U.S. population is growing that rapidly.

Then drug overdose death rates jumped 35% in 2020.

In this post, I will look at which age groups were affected, and by how much. And whether it looks like the effect moderated in 2021.

Spoiler: it didn’t.

In this post:

Drug ODs were over 25% of deaths for adults aged 25-34 years old in 2020
The highest rate increase was for age 15-19 years old, with over 100% increase in drug OD death rates
Age groups with the highest drug OD death rates were age 25 - 54 in 2020, but also pre-pandemic
Drug OD deaths continued to increase in 2021 through June 2021
Fentanyl has been the primary driver in large drug OD death rate increases in recent years, and especially during the pandemic
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Prominence of drug overdose deaths among adults

Before even looking at how much overdoses increased in 2020 by age group, I want to show how significant drug overdose deaths are by age group:

At over a quarter of deaths for those age 25-34 years old, this is a very significant cause of death for young adults. It was one-fifth of the deaths of those age 20-24 in 2020.

While we will see that the death rates increased drastically for multiple age groups in 2020, as a percentage of total deaths for age groups, it’s most prominent for ages 20-44.

At older ages, far more deaths are due to natural causes, like cancer and heart disease. And, in 2020, COVID.

At younger ages, more deaths are due to motor vehicle accidents and other accidental causes of death.

I did pull data for all ages, but drug overdose deaths under age 15 were so few that there were unreliable statistics for any analysis. When we see overall trends below, even for age 15-19, we are generally looking at fewer than 1,000 deaths per year. Except for 2020, when it went above 1,000 deaths for the whole country for that group.

Percentage change in death rate by age group

As with the other causes of death that changed a great deal from 2019 to 2020, we see some stark differences by age group:

When I graph out each of these groupings over the full period of 1999-2020, the large increase for age 15-19 will be starker than what we see here. That’s over a 100% increase. To be sure, it’s a small rate to begin with, but as most of the people in this group are still minors, and of those who are not minors, most are still living with their parents, such a large increase is concerning.

Drug overdoses at old ages may not be overdoses of illicit drugs, of course, but may be accidental poisonings from medications the people are taking for their myriad health problems. It may be that during 2020, there were more problems with the oldest people not having enough medical supervision over their medications and accidental deaths due to medication problems. The rate is low compared to the drug overdose death rates of young adults.

And that’s where the big pain is: ages 25 – 54, and 54 isn’t even young (I’m in the age 45-54 bucket myself). These age groups had the highest drug overdose death rates before and those jumped even higher in 2020.

The age 20-24 group saw an almost 50% increase in their death rates due to drug overdoses, but their death rate stayed relatively moderate, below that of the 55-64 death rate pre-pandemic. For those in middle age, some of drug overdoses may be due to pain killer addictions. The “Battlestar Sciatica” memes that have been going around are no joke, my friend.

Not sure why it’s only men in that picture. Plenty of women have the problem, too. I know I do.

In any case, drug overdoses stem from a variety of causes, with the primary driver currently being fentanyl. More at the end of this post.

Drug overdose trends by age group, 1999-2020

I will do these in groupings a little different from my other posts, because these trends don’t behave nicely in contiguous age groups. That is, there can be quite different scales we’re looking at for drug overdose death rates.

First, let us look at the age groups with the highest death rates due to drug overdose:

Running from age 25 to 54, at least this grouping is contiguous. These three are the major age grouping driving the overall age-adjusted death rate for drug overdoses, as this is where the peak drug overdose deaths are coming from.

This is showing the same overall growth rate we saw for the overall population, with the approximately 35% increase in 2020.

Let’s look at the next tier of death rates:

This is where it starts to get messy. The age 65-74 rate trajectory, for instance, looks different from the other two, and from the highest rates we saw earlier. This may be driven partly by drug poisonings from misuse/poor use of prescription drugs. The smoothness of this curve may be that there are a couple distinct populations being blended here, with the younger seniors still potentially overdosing on illicit drugs, with older seniors in this band having reactions to prescription medications as they have more and more health problems.

The age 20-24 band is intriguing to me, because it doesn’t climb as rapidly at the 25-34 group. From some statistics I know, this may be related to young adults being more likely to still being at home. Their opportunities of getting into “trouble” may be less. But also, younger adults have been more financially constrained, and they may just not be able to buy the drugs on which to OD. Also, being younger, they may be more likely to be able to survive an adverse run-in with fentanyl, where they may not be when they’re 10 years old.

The age 55-64 group is very similar to the trajectory of the highest rate groups, but to a lesser degree. There may be some survivorship bias involved, which may explain the lower rate in this group. But also, there may be a mix of people using pain medications for their very real physical pains.

Final grouping:

These are the groups with the lowest death rates due to drug overdoses. Addressing the oldest groups first, it’s good to see that these are somewhat level. This may be a true reflection of a death rate that is due to mis-medication as opposed to what we usually think with respect to drug overdoses. (When I filter for this cause of death, I was not selecting a specific drug. I simply chose accidental drug poisonings, which is where drug overdoses land.)

The age 15-19 age group trajectory wasn’t too concerning… until we hit 2020. Now, that’s hideous, and on this scale, you can really see the over 100% increase. Of course, a 6.4 per 100,000 rate is very small compared to the peak rate of 50 seen among 35-44-year-olds.

But from a relative risk point of view, we definitely don’t want to be seeing a 100% increase. Especially if we’re concerned that the rate didn’t come down again in 2021, and concerned whether it will not come down in 2022.

Provisional drug overdose trends by quarter through 2021Q2

For our final set of graphs, I am graphing the quarterly drug overdose deaths by 5-year age groups, through the second quarter of 2021 (i.e. through the end of June 2021), the last quarter for which I have full data.

I will make overall remarks at the end of these five graphs. Note that all the vertical scales start at 0, but have very different maximum points for the scales. This is important.

Ages 15-24:

Ages 25-39:

Ages 40-54:

Ages 55-69:

Ages 70+:

First, all the age groups for which drug overdose deaths jumped up, it jumped up by a large amount in the second quarter of 2020 (April – June 2020). Most of these cases, it jumped up around 40% compared to the first quarter.

Over age 75, there wasn’t a large jump up. For age 75-79, the numbers slowly drifted upwards. For age 80+, it was fairly level.

For the younger ages, after the 2020Q2 jump up, death numbers came down in 2020Q3 (summer) and 2020Q4 (fall), but rose again in the first two quarters of 2021.

In most cases, the number of drug overdose deaths in 2021Q2 were higher than 2020Q2. This is not a good trend.

Fentanyl: the main driver of recent trends

One of the known drivers of recent bad trends in drug overdoses – this is from before the pandemic – is fentanyl.

Oh, look what just hit the news. From CNN: 6 West Point cadets overdose on fentanyl during spring break, police say

Six West Point cadets on spring break in Fort Lauderdale were hospitalized after overdosing on a powder substance laced with the drug fentanyl, police said Friday.
Authorities in Broward County, Florida, have made an arrest in connection to the overdoses, which happened Thursday in a vacation rental house in Wilton Manors, according to a news release from the Wilton Manors Police Department.
The Fort Lauderdale Fire Rescue responded to the house around 5 p.m. Thursday and aided six male college students, who were feeling overdose symptoms and taken to hospitals. A woman was also hospitalized after feeling sick, police said.
A hazmat team tested the powdered material and found that it was laced with fentanyl, an opioid drug, according to the department.
….
Fentanyl is a synthetic drug that can be up to 50 times stronger than heroin, up to 100 times stronger than morphine and commonly resembles prescription drugs, according to the US Centers for Disease Control and Prevention. It is often added to other drugs by dealers “because of its extreme potency, which makes drugs cheaper, more powerful, more addictive, and more dangerous,” the CDC said.

For a while, people had been blaming the trend on Oxycontin, and there is some truth to that for the early 2000s, but the recent skyrocketing rates are almost entirely due to fentanyl-laced illicit drugs.

Fentanyl has licit uses, by the way, in anesthesia.

But you can check out official stats by drug, and you’ll see which drugs are to blame.

Fentanyl is just far deadlier than the others in terms of how thin the line is between effective dose and killing dose.

That is not necessarily of concern in a precision environment, such as surgery, under the supervision of an anesthetist.

It is of concern if you’re on spring break, and the dealer you got your supply from wasn’t too careful about how they dosed the batch.

The CNN piece closes:

Last year saw a record high of drug overdose deaths, with more than 100,000 people dying from April 2020 to April 2021, according to provisional data published in November by the CDC. It was a 28.5% spike compared to the same period a year earlier and nearly doubling over the past five years.

My data end with the end of June 2021, and yes, if I just compare total deaths due to drug overdoses, July 2019-June 2020 (which includes the spike of 2020 drug ODs in spring 2020) versus July 2020-June 2021, this is my result: 23% increase.

The pain definitely continued into 2021.

The question is whether it will continue into 2022.

UPDATE: Spreadsheets attached

Drug Overdose Age Groups 1999 2021

178KB ∙ XLSX File

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Quarterly Number Of Deaths By Drug Overdose Age Group 2018 June 2021 Provisional

120KB ∙ XLSX File

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