The U.S. drug overdose crisis has been described as a national disaster that has affected all communities. But overdose rates are higher among some subpopulations and in some places than they are in others. This article describes demographic (sex, racial/ethnic, age) and geographic variation in fatal drug overdose rates in the United States from 1999 to 2020. Across most of that timespan, rates were highest among young and middle-age (25-54 years) White and American Indian males and middle-age and older (45+ years) Black males. Rates have been consistently high in Appalachia, but the crisis has spread to several other regions in recent years, and rates are high across the urban-rural continuum. Opioids have been the main contributor, but overdoses involving cocaine and psychostimulants have also increased dramatically in recent years, demonstrating that our problem is bigger than opioids. Evidence suggests that supply-side interventions are unlikely to be effective in reducing overdoses. I argue that the U.S. should invest in policies that address the upstream structural drivers of the crisis.
Although the detrimental effects of the opioid epidemic on health and wellbeing have been well documented, we know little about how it has affected the family contexts in which children live. Using data from the 2000 Census, the 2005-2018 American Community Survey (ACS) and restricted Vital Statistics, we assess how the opioid epidemic, as measured by a rise in the opioid overdose death rate, affected the rates of children living in different family arrangements: two married parents, two cohabiting parents, single mother, single father, or another configuration. According to local fixed-effects models, a higher opioid overdose death rate is associated with fewer children living with two married parents and an increase in children living in family structures that tend to be less stable, such as those led by cohabiting parents or a single father. These changes in family arrangements have potential long-term implications for the wellbeing of future generations.