Among privately insured patients using medical services from 2019 to 2021, the proportion of patients with opioid and opioid-like drug overdoses rose in 42 states, with increases ranging from 148.4% in Pennsylvania to 0.7% in Minnesota. Only eight states and the District of Columbia saw decreases over the same period.
These are among the key findings in a new study released by our organization, FAIR Health, that draws on the nation’s largest repository of private health care claims to shed light on the prevalence of overdoses before and during the COVID-19 pandemic.
From 2016 to 2021 overall, the analysis shows, the share of patients with a drug overdose diagnosis among all patients using medical services increased by 10.2%. From 2019 to 2021 alone, the increase was 4.3%.
Percent change in patients with opioid and opioid-like drug overdoses (encompassing substances such as heroin and fentanyl) among the total number of patients using medical services by state, 2019-2021.(FAIR HEALTH)
Overdoses by Age
The increases in drug overdoses varied among age groups. From 2016 to 2021, the percentage of patients with an overdose diagnosis rose the most among those 18 and under – by 26.9% – while those 65 and older saw a 24.5% increase. Those 19 to 35 years old were the only age group that saw a decrease in that period, with the share of patients with an overdose diagnosis dropping by 4.1%.
Substances
The distribution of substances associated with overdoses remained fairly steady from 2019 to 2021. The largest change occurred among overdoses involving prescribed medications – such as cardiac drugs and antirheumatics – which increased from 44% of the distribution in 2019 to 48% in 2021. The share of patients with a prescribed medication overdose rose the most among those 65 and older from 2016 to 2021, with a 38.3% increase, followed by a 37.6% increase among those 51 to 64.
Notably, opioids and opioid-like substances – which are involved in the majority of fatal overdoses in the U.S. each year, according to the Centers for Disease Control and Prevention – accounted for 5% of overdoses in our data in 2021.
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Overdoses by Gender
In each year from 2016 to 2021, females accounted for 60% to 61% of patients with an overdose diagnosis, while males made up 39% to 40%.
The gender distribution was reversed for substance use disorder diagnoses. In each year from 2016 to 2021, males accounted for 62% to 63% of patients with a substance use disorder diagnosis, while females made up 37% to 38%.
Incidence
FAIR Health also investigated the incidence – or the number of new cases – of overdose diagnoses. To be counted as an incident case, patients needed to have at least one insurance claim of any kind at least one year prior to the first date of overdose diagnosis, but no prior overdose or substance use disorder diagnosis.
For most months in 2020, the percentage of incident patients with an overdose diagnosis and no prior overdose or substance use disorder diagnosis out of all patients using medical services that year was below that of 2019, though a marked month-over-month increase occurred in December.
In 2021, there was a month-over-month increase in the percentage of incident patients in each month compared with the two prior years.
Percent of patients with an incident overdose diagnosis, 2019-2021.(FAIR HEALTH)
Geography
In 2019, the proportion of privately insured patients diagnosed with an overdose out of the total number of patients who used medical services varied from state to state, with a low of 0.264% in Connecticut and a high of 0.772% in New Mexico. In 2019, the five states with the highest proportions of patients who had an overdose diagnosis were New Mexico, Oklahoma, Massachusetts, West Virginia and Arizona. The five jurisdictions with the lowest proportions of patients with an overdose diagnosis in 2019 were Connecticut, North Carolina, Maryland, Maine and the District of Columbia.
In 2021, the proportion of privately insured patients diagnosed with an overdose again varied from one jurisdiction to another, with a low of 0.158% in the District of Columbia and a high of 0.67% in New Mexico. Among the five states that had the highest shares of patients with an overdose diagnosis, New Mexico and Oklahoma remained in the top two spots while Wisconsin became third, Massachusetts dropped from third to fourth, and Montana became fifth.
The five jurisdictions with the lowest shares of overdose patients were also somewhat similar. The District of Columbia rose from fifth to first place; Rhode Island entered the list in second place; Maine rose from fourth to third place; Tennessee entered the list in fourth place; and Connecticut dropped from having the lowest percentage of overdoses to having the fifth-lowest.
Maryland topped the list of states with the greatest increases from 2019 to 2021 in the proportion of patients who had an overdose diagnosis, with a 25.4% increase from 0.31% of the population using medical services to 0.38% (population proportions are rounded). Minnesota was in second place with a 19.5% increase – from 0.37% of the population using medical services to 0.44%. Arizona, South Dakota and Mississippi saw increases of 18.1%, 17.0% and 16.1%, respectively, to round out the top five.
States with the greatest increases in percentage of patients with an overdose diagnosis among total patients using medical services, 2019-2021.(FAIR HEALTH)
Preexisting Mental Health Conditions
Of all patients who had a substance use disorder or overdose diagnosis in 2021, 65% had a preexisting mental health condition. Among overdose patients, generalized anxiety disorder (at 27.1% of the distribution of such patients with preexisting mental health diagnoses) and major depressive disorder (at 24.8%) were the two most common mental health diagnoses. In third through fifth place were adjustment disorders (12.4%), bipolar disorder (5.9%) and attention-deficit hyperactivity disorder (5.5%).
The findings in the new study have implications for stakeholders across the health care spectrum, including patients, providers, payers and policymakers. We hope they also offer starting points for further research on overdoses before and during the COVID-19 pandemic.
