Comparing mortality from covid-19 to mortality due to overdose: A micromort analysis

Highlight

• Significant proportion of Canadians self-reported increased maladaptive behaviours, particularly younger and middle-aged adults.

• Illicit drug toxicity deaths increased during the pandemic and surpassed the peak mortality risk observed at the height of the opioid crisis in 2018.

• May indicate a rise in opioid consumption and/or suicide.

• Interventions to mitigate covid-19 risk should be informed by consideration of not only physical health, but also mental health and social well-being, and should not have the externality of increasing mortality due to other causes.

Abstract

Objective

To compare the mortality risk due to covid-19 with death due to overdose in British Columbia, Canada. The opioid epidemic was declared a public health emergency in 2016.

Methods

Mortality risk was calculated in micromorts with covid-19 data for January–October 2020, derived from the BC center for Disease Control, and illicit drug toxicity deaths for January 2010–September 2020, derived from the BC Coroners Service. Age-stratified covid-19 incidence and deaths per 100,000 population and age-stratified illicit drug toxicity death rates per 100,000 population were calculated. A micromort is a unit of risk equivalent to a one-in-a-million chance of death.

Results

During the covid-19 pandemic, illicit drug toxicity deaths reached 1.0 micromorts per day, representing an increase of 0.5 micromorts per day relative to 2019 rates. In comparison, covid-19 mortality risk was 0.05 micromorts per day among individuals from the general population living in British Columbia and 21.1 micromorts per day among those infected with covid-19. Covid-related mortality risk was significantly lower among individuals aged <60 years, relative to older adults, whereas drug toxicity-related mortality was highest for individuals aged 30–59 years.

Conclusions

The mortality associated with covid-19 is apparent and distributed unevenly across subpopulations. The mortality due to overdose has increased during covid-19 and exceeds mortality due to covid-19. Our results instantiate the triple threat caused by covid-19 (i.e., public health crisis, economic crisis and mental health crisis) and quantitatively highlight the externality of increased mortality due to deaths of despair in response to public health efforts to reduce covid-related mortality.