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Mortality

Epidemic within a Pandemic: Opioid Misuse and Mortality Risk through 2020

opioid misuse_2020_long

An increase in opioid misuse contributed to a rise in overdose mortality in 2020.

The ongoing epidemic has had significant effects on mortality experience in the United States. Using the Centers for Disease Control and Prevention's Multiple Cause of Death mortality data (MCOD), RGA has analyzed U.S. overdose mortality, aggregating experience data by several demographic characteristics to better understand opioid-related deaths. Further analysis explored the opioid-related mortality trends during the COVID-19 pandemic, as well as the rising concern of fentanyl and synthetic opioid misuse.

This report extends an analysis of opioid mortality risk published at the end of 2019; this report includes data through 2020 that was obtained in early 2022.

Key findings:

  • Opioid-related deaths began to rise in 2015 but leveled off between 2018-2019. However, the number of opioid-related deaths were much higher in 2020 than previous years, with a peak in May 2020, coinciding with social isolation measures early in the COVID-19 pandemic. While individuals of all educational attainment levels showed increases in opioid-related mortality rates, those without any college-level education exhibited the highest increases.
  • Overdoses involving fentanyl and synthetic opioids have continued to increase, while other opioid-related drug overdoses have remained constant or have decreased.
  • Opioid-related mortality rates vary by age, sex, marital status, and occupation. Groups exhibiting higher mortality rates relative to their peers include males, people who have never been married, and workers in construction-related jobs. Opioid-related overdose mortality rates for university-educated people generally decline with age, and while rates for males decrease with age, rates for females peak in middle age.

Overdose deaths increased drastically in 2020 after experiencing a slowdown in 2018-2019.


The increase in overdose deaths was primarily driven by opioid-related deaths.

Total overdose deaths have generally trended upward since 2005, with a recent and sudden spike in 2020. This spike was more pronounced for opioid drugs than for non-opioid drugs. 

Opioid Mortality 2020 Figure 1 
Source: RGA analysis of mortality data from the MCOD.

Opioid-related deaths peaked in May 2020.

In May 2020, while many individuals remained in isolation due to the COVID-19 pandemic, opioid-related deaths spiked. While the number of opioid-related deaths declined after May 2020, the number of opioid deaths was consistently higher each month of 2020 relative to the same months in 2018 and 2019.

Opioid Mortality 2020 Figure 2

Source: RGA analysis of mortality data from the MCOD.

Fentanyl and synthetics were the most common type of opioid drug contributing to 2020 deaths.

While deaths from all opioid drug types peaked in May 2020, fentanyl and synthetic opioids experienced the largest spike. Fentanyl and synthetic opioid deaths nearly doubled from January 2020 to May 2020, and totaled more than three times the number of prescription opioid deaths throughout 2020.

Opioid Mortality 2020 Figure 3 
Source: RGA analysis of mortality data from the MCOD.

People with lower levels of education experienced higher and more rapidly-increasing opioid-related mortality rates.

All education levels experienced an increase in opioid-related mortality rates over time; however, this increase was much more dramatic for people with lower levels of education. Individuals without any college-level education experienced the highest opioid-related mortality rates in 2020, nearly 11 times the rate for individuals who have at least a bachelor's degree.

Opioid Mortality 2020 Figure 4

Source: RGA analysis of mortality data from the MCOD and population data from the U.S. Census Bureau.

Fentanyl and synthetic opioids have become increasingly prevalent in opioid-related deaths.


University-educated people experienced a dramatic increase in opioid-related mortality rates due to fentanyl and synthetic opioids in recent years.

For university-educated individuals, the fentanyl and synthetic opioid overdose rate has followed a sharp, upward trend since 2013. Conversely, the overdose rates for heroin, prescription, and other opioids have generally declined or remained constant.

Opioid Mortality 2020 Figure 5

Source: RGA analysis of mortality data from the MCOD and population data from the U.S. Census Bureau.

Younger individuals are more likely to have an opioid-related death due to synthetic opioids.

Most opioid-related deaths in 2020 involved synthetic opioids, especially at younger ages. The proportion of prescription opioid deaths increases with age.

Opioid Mortality 2020 Figure 6

Source: RGA analysis of mortality data from the MCOD.

Chart note: Some deaths involved more than one opioid, so the sum of the prevalence of all opioid types may be larger than 100%.

Opioid overdose rates differ by demographic factors including sex, marital status, and occupation.


Males generally present a much higher opioid-related mortality rate than females.

Opioid-related mortality rates are about 2.2 times higher for males than females. The difference by sex remains in effect for those without a college degree, with the largest difference occurring for those aged 30 through 34 and declining with age.

Opioid Mortality 2020 Figure 7

Source: RGA analysis of mortality data from the MCOD and population data from the U.S. Census Bureau.

Never-married individuals have disproportionately higher opioid-related mortality than individuals who have married before.

Never-married individuals generally have 4-5 times the opioid mortality rates of their once-married counterparts.

Opioid Mortality 2020 Figure 8

Source: RGA analysis of mortality data from the MCOD and population data from the U.S. Census Bureau.

Chart note: The most recent year of population data available at the time of analysis was 2019. Due to limitations in the population dataset, this analysis was based on civilians of all education levels; it was not limited to university-educated individuals, as done in some of the other analyses.

People with construction-related jobs have an opioid-related mortality rate eight times higher than the rate of those with business/science-related jobs.

While accounting for only about 9% of the workforce, construction-related employees made up nearly 29% of opioid-related deaths. This represents the highest opioid-related mortality rate out of the five main occupation types defined by the U.S. Census Bureau.

Business/science-related occupations have the lowest opioid-related mortality rate. Production-related and service-related occupations present significantly higher mortality rates than business/science-related jobs.

Opioid Mortality 2020 Figure 9

Source: RGA analysis of mortality data from the MCOD and population data from the U.S. Census Bureau.

Chart note: The most recent year of population data available at the time of analysis was 2018. Due to limitations in the population dataset, this analysis was based on civilians of all education levels who were ages 16+; it was not limited to university-educated individuals nor ages 25+, as done in some of the other analyses.

Chart note: Occupation Types

  • Business/science-related jobs include management, business, science, and arts occupations.
  • Construction-related jobs include natural resource, construction, and maintenance occupations.
  • Production-related jobs include production, transportation, and material moving occupations.
  • Office-related jobs include sales and office occupations.
  • Service-related jobs include service occupations.

Summary

Historical increases in opioid-related mortality began to subside in 2018-2019 but increased dramatically in 2020. The peak of the 2020 increase occurred in May, coinciding with social isolation measures early in the COVID-19 pandemic. Individuals with lower educational attainment levels exhibited the largest increases in opioid-related overdose mortality. Overdoses involving fentanyl and synthetic opioids continued to rise, while other opioid-related overdoses remained constant or decreasing. Age, sex, marital status, and occupation are key factors that influence opioid-related mortality experience.



Footnotes

Opioid types depicted in the charts were derived from the following ICD-10 codes:

  • Heroin - Contributing cause of death T401
  • Prescription Opioids - Contributing cause of death T402
  • Fentanyl & Synthetic Opioids - Contributing cause of death T404
  • Other Opioids - Contributing cause of death T400, T403, and/or T406

References

National Center for Health Statistics. (2022). Retrieved from https://www.cdc.gov/nchs/index.htm

U.S. Census Bureau. (2021). 2018 American Community Survey 1-Year Estimates. Retrieved from https://www.census.gov/data/tables.html

U.S. Census Bureau. (2020). 2019 Current Population Survey, Annual Social and Economic Supplement. Retrieved from https://www.census.gov/data/tables.html

U.S. Census Bureau, Population Division. (2019). Table 1. Monthly Population Estimates for the United States: April 1, 2010 to December 1, 2020. Retrieved from https://www.census.gov/data/tables/time-series/demo/popest/2010s-national-total.html

U.S. Census Bureau, Population Division. (2021). Monthly Population Estimates for the United States: April 1, 2020 to December 1, 2022. Retrieved from https://www.census.gov/data/tables/time-series/demo/popest/2020s-national-total.html

The Authors

  • Julianne Callaway
    FSA, ACAS, MAAA
    Vice President and Actuary
    Strategic Research
    Global Actuarial Pricing and Research (GAPR) 
    Send email >
  • Kaitlyn Fleigle

    ASA, CERA
    Senior Assistant Actuary
    Strategic Research
    Global Actuarial Pricing and Research (GAPR)
    RGA

  • Johanna Svensson

    Intern
    Strategic Research
    Global Actuarial Pricing and Research (GAPR)
    RGA

Summary

The opioid crisis and the ongoing COVID-19 pandemic are intersecting with each other, significantly impacting mortality experience in the United States. In this research, RGA experts analyzed U.S. overdose mortality, aggregating experience data by several demographic characteristics to better understand opioid related-deaths.

  • covid mortality
  • covid pandemic
  • data analysis
  • data science
  • fentanyl
  • opioid crisis
  • opioid epidemic
  • opioid misuse
  • opioid mortality
  • opioid mortality data
  • opioid mortality risk
  • opioid overdose
  • overdose deaths
  • prescription opioid deaths
  • synthetic drugs
  • synthetics