Survey: 82.7 million Americans impacted by overdose deaths

Johns Hopkins Bloomberg School of Public HealthMay 31 2024

Losing a loved one to drug overdose has been a common experience for many Americans in recent years, crossing political and socioeconomic divides and boosting the perceived importance of the overdose crisis as a policy issue, according to a new survey led by researchers at the Johns Hopkins Bloomberg School of Public Health.

A nationally representative survey of more than 2,300 Americans, fielded in spring 2023, suggests that 32 percent of the U.S. adult population, or an estimated 82.7 million individuals, has lost someone they know to a fatal drug overdose. For nearly one-fifth of survey respondents-;18.9 percent, representing an estimated 48.9 million adults-;the person they knew who died of overdose was a family member or close friend.

The rates of reported loss due to overdose did not differ significantly by political party affiliation, but those who experienced overdose loss were more likely to view addiction as an extremely or very important policy issue.

The study will be published online May 31 in JAMA Health Forum.

"The drug overdose crisis is a national tragedy," says Alene Kennedy-Hendricks, PhD, assistant professor in the Department of Health Policy and Management at the Bloomberg School, who led the analysis. "Although large numbers of U.S. adults are bereaved due to overdose, they may not be as visible as other groups who have lost loved ones to less stigmatized health issues. Movements to build support for policy change to overcome the devastating toll of the overdose crisis should consider the role of this community."

Over one million Americans have died from drug overdoses since the late 1990s, including more than 100,000 per year in the last few years, according to the Centers for Disease Control and Prevention. Last year, overdose deaths declined slightly for the first time in five years, decreasing three percent from 2022, according to preliminary data from the CDC's National Center for Health Statistics. At about 108,000 estimated deaths, the CDC 2023 preliminary numbers remain near historic highs. 

The overdose crisis has evolved over several phases, beginning with prescription opioids such as oxycodone playing a key role, followed by heroin and, more recently, powerful synthetic opioids like illicitly manufactured fentanyl and polysubstance use. Opioids can suppress breathing as a side effect, and the unpredictability of the illicit drug supply and the potency of fentanyl have dramatically increased the risk of overdose.

While the survey questions did not specifically identify opioids, the majority of overdose deaths over the last two decades have been opioid-related.

The overdose crisis has not only impacted its direct victims but also their relatives, friends, and acquaintances. Kennedy-Hendricks and her colleagues at the Bloomberg School's Center for Mental Health and Addiction Policy set up the study to help illuminate this wider impact, which otherwise has been little studied.

The paper was co-written with colleagues from Boston University School of Public Health, the University of Minnesota, and the de Beaumont Foundation. The study's senior author is Sandro Galea, MD, DrPH, MPH, dean of Boston University School of Public Health. 

The survey is part of the CLIMB (COVID-19 and Life Stressors Impact on Mental Health and Well-being) study. Led by Catherine Ettman, PhD, an assistant professor in the Bloomberg School's Department of Health Policy and Management, the CLIMB study has surveyed a nationally representative sample of adult Americans annually since 2020. For this overdose loss study, questions to participants from March 28 to April 17, 2023-;CLIMB Wave 4-;included "Do you personally know anyone who has died from a drug overdose?" A total of 2,326 participants responded to the question. Participants answering "yes" were then asked "Who do you know that has died from a drug overdose?" 

Overdose losses were reported across all income groups. Forty percent of lower-income respondents (defined as annual household incomes less than $30,000) reported overdose loss. Over one-quarter-;26 percent-;of respondents in the $100,000 and higher annual household income category reported an overdose loss.

The rate of reported overdose loss was not significantly different across self-described Republicans, Democrats, and Independents, adding to the picture of a far-reaching phenomenon.

The data suggested a high level of endorsement across all groups-;greater than 60 percent, even among those reporting no overdose loss-;that addiction is an extremely or very important policy issue. Respondents who reported overdose loss had 37 percent greater odds of viewing addiction as a very or extremely important policy priority. 

This study contributes new evidence that the addiction crisis and the losses that come with it are common across Americans, but the burden is greater among those who are more economically precarious. Addressing addiction can be a unifying theme in increasingly divided times."

Catherine Ettman, PhD, assistant professor in the Bloomberg School's Department of Health Policy and Management

The researchers plan to follow up with further studies in future CLIMB survey waves, looking at associations between overdose loss and other social variables such as trust in institutions.

"The Scale of Personal Loss Incurred by the Drug Overdose Crisis in the U.S." was co-authored by Alene Kennedy-Hendricks, Catherine Ettman, Sarah Gollust, Sachini Bandara, Salma Abdalla, Brian Castrucci, and Sandro Galea.

CLIMB Study Wave 4 was funded by a grant from the de Beaumont Foundation.