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Principal Investigator: Magdalena Cerda
Organization: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
Fiscal Year: 2024
Award: $998,506
Funding agency: National Institute on Drug Abuse
Overdose has risen sharply during the COVID-19 pandemic, highlighting an urgent need to understand the
impact of disasters on overdose. We need research to identify the types of policy measures that can prevent a
similar increase in overdose in future disasters. We also need to understand why certain communities are
particularly vulnerable to experiencing rises in overdose during and after a disaster, so that we can optimally
target prevention and disaster response efforts. We propose to use Big Events Theory as a framework to: 1)
study the COVID-19 pandemic and its effects on overdose and related outcomes; 2) identify policy responses
to COVID-19 that affected individual-level overdose risk; and 3) examine how the pandemic's impact on
overdose risk varied across communities and populations. We hypothesize that COVID-19 containment
policies (e.g., workplace closings) contributed to social isolation, increasing the risk of consuming drugs alone
and limiting access to treatment and harm reduction services, thus increasing overdose risk. In contrast, public
health (e.g., take-home methadone waivers) and economic support policy responses to COVID-19 (e.g.,
housing eviction moratoria) may have eased access to health services for people who use drugs (PWUD) and
alleviated economic difficulties arising from the pandemic, blocking health and economic pathways through
which the pandemic could increase overdose risk. We hypothesize that communities with more structural
sources of despair (e.g., high rates of unemployment, poverty), and those that concurrently experienced other
major societal crises (natural disasters, political conflict, mass shootings) were more vulnerable to the effects
of COVID-19 on overdose. In contrast, social and economic policies enacted before the pandemic to protect
vulnerable populations (e.g., higher state Medicaid income threshold) may have reduced the impact of the
pandemic on overdose risk. Our Aims are to: (1) Determine how individual overdose risk in localities
(overall and by race/ethnicity) changed over 2019–2025 after county-level elevations in COVID-19 health
burden (hospitalizations, deaths). (2) Determine which county- and state-level policies targeting COVID-19
infection containment, public health of PWUDs, and economic support during the pandemic mediated
relations between changes in county-level COVID-19 burden and changes in overdose incidence, overall and
by race/ethnicity. (3) Identify which community conditions affected the strength of the relationships
between changes in county-level COVID-19 burden and individual overdose risk, overall and by race/ethnicity,
including: a) pre-existing community structural characteristics (e.g., poverty rate); b) pre-existing policies to
protect vulnerable populations (e.g., state Medicaid program income threshold); and c) intersecting crises. 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 COVID-19 burden on individual overdose risk. Our study findings will inform
the response to the current overdose crisis and to future disasters.
Terms: <Access to Care><Actiq><Adanon><Address><Adoption><Adverse drug effect><Affect><Althose><Black><Black Populations><Black group><Black individual><Black people><Black race><Blacks><Buffers><COVID burden><COVID crisis><COVID epidemic><COVID pandemic><COVID-19><COVID-19 affected><COVID-19 burden><COVID-19 consequence><COVID-19 crisis><COVID-19 disease burden><COVID-19 effect><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health burden><COVID-19 health crisis><COVID-19 impact><COVID-19 impacted><COVID-19 infection><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 related burden><COVID-19 virus infection><COVID-19 years><COVID19 infection><CV-19><Cessation of life><Characteristics><Communities><Conflict><Conflict (Psychology)><Consumption><Containment><Coronavirus Infectious Disease 2019><Country><County><Death><Death Rate><Diagnosis><Disasters><Dolophine><Drug usage><Drug user><Drugs><Duragesic><Economic Income><Economic Policy><Economical Income><Economically Deprived Population><Economics><Ethnic Origin><Ethnicity><Event><Fentanest><Fentanyl><Fentyl><Future><Harm Minimization><Harm Reduction><Health><Health Services><Health Services Accessibility><Heterogeneity><Hispanic Populations><Hispanic group><Hispanic individual><Hispanic people><Hispanics><Home><Hospital Admission><Hospitalization><Housing><Impoverished><Incidence><Income><Individual><Inequality><Inequity><Investigation><Job Location><Job Place><Job Setting><Job Site><Knowledge><Measures><Mediating><Medicaid><Medication><Methadone><Methadose><Modeling><Naloxone><Narcan><Narcanti><Natural Disasters><Outcome><Overdose><PWUD><Pathway interactions><Patients><Pattern><Pharmaceutical Preparations><Phentanyl><Policies><Politics><Population><Poverty><Prevalence><Prevention><Public Health><Public Policy><Race><Races><Relapse><Research><Research Design><Risk><Role><SARS-CoV-2 burden><SARS-CoV-2 disease burden><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 infection><SARS-CoV-2 infection burden><SARS-CoV-2 pandemic><SARS-CoV2 infection><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Salaries><Services><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 infection><Severe acute respiratory syndrome coronavirus 2 pandemic><Social Policies><Social isolation><Source><Structure><Study Type><Subgroup><Testing><Unemployment><Urban Community><Vulnerable Populations><Wages><Wing><Work Location><Work Place><Work-Site><Workplace><Worksite><access to health services><access to services><access to treatment><accessibility to health services><aged><availability of services><care access><climate change><climatic changes><cohort><coronavirus disease 2019><coronavirus disease 2019 consequence><coronavirus disease 2019 crisis><coronavirus disease 2019 effect><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 impact><coronavirus disease 2019 infection><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19><coronavirus disease-19 global pandemic><coronavirus disease-19 impact><coronavirus disease-19 pandemic><coronavirus infectious disease-19><drug market><drug use><drug-related adverse effects><drug/agent><economic><economically deprived group><economically deprived people><economically disadvantaged group><economically disadvantaged individual><economically disadvantaged people><economically disadvantaged population><experience><future pandemic><global climate change><health service access><health services availability><homes><improved><incomes><infected with COVID-19><infected with COVID19><infected with SARS-CoV-2><infected with SARS-CoV2><infected with coronavirus disease 2019><infected with severe acute respiratory syndrome coronavirus 2><insight><jobless><joblessness><long term COVID-19 pandemic consequences><long term COVID-19 pandemic effects><long term COVID-19 pandemic impacts><longer term COVID-19 pandemic consequences><longer term COVID-19 pandemic effects><longer term COVID-19 pandemic impacts><man><mass shooting><mortality rate><mortality ratio><next pandemic><opiate use disorder><opioid use disorder><out of work><overdose risk><pandemic><pandemic disease><pandemic effect><pandemic impact><pandemic outcome><pandemic repercussions><pathway><people who use drugs><people who use illicit drugs><persons who use drugs><prevent><preventing><programs><racial><racial background><racial origin><residential segregation><response><service availability><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><social><social disadvantage><social disparities><social inequality><social role><study design><theories><treatment access><underclass><unemployed><vulnerable group><vulnerable individual><vulnerable people><waiver><work setting>