Understanding the short- and long-term effects of disasters and other Big Events on the overdose crisis

Overdose mortality rates rise in response to disasters and other major events such as epidemics, highlighting an urgent need to better understand the impact of societal crises on overdose and to identify the types of policy measures that can prevent a similar increase in overdose in future crises. We also need to understand why certain communities are particularly likely to experience rises in overdose during and after a major event, so that we can optimally target prevention and response efforts. We propose to use Big Events Theory as a framework to: 1) study the effect of disasters and other major events such as epidemics on overdose and related outcomes; 2) identify policy responses to major events that affect individual-level overdose risk; and 3) examine how the impact of disasters and other major events on overdose risk varied across communities and populations. We hypothesize that policies aimed at containing the population impact of disasters and other major events may contribute to social disruption, increasing the risk of consuming drugs alone and limiting access to treatment and harm reduction services, thus increasing overdose risk. In contrast, policies that ease access to health services for people who use drugs and alleviate economic difficulties arising from disasters and other major events, may block health and economic pathways through which major events can increase overdose risk. We will also examine what local characteristics explain heterogeneity in the impact of local disaster burden on overdose. Our Aims are to: (1) Determine how individual overdose risk in localities changed over 2019–2025 after county-level exposure to disasters and other major events such as epidemics. (2) Determine which county- and state-level policies mediated relations between changes in county exposure to major events and changes in overdose incidence. (3) Identify which community conditions affected the strength of the relationships between changes in county-level exposure to major events and individual overdose risk, including: a) pre-existing community sociodemographic characteristics; b) pre-existing social and economic policies; and c) other co-occurring disasters. We will build a multi-center cohort of ~2.4 million patients aged 18+ in six PCORnet® networks across the country to track the impact of community disaster burden on individual overdose risk. Our study findings will inform the response to the current overdose crisis and to future disasters.