County-level variation in synthetic opioid and heroin overdose incidents in Pennsylvania during the COVID-19 pandemic

Objective: Evaluate differences in synthetic opioid overdose rates, including semi-synthetic heroin, by individual demographic (N = 14,665) and county-level (N = 67) characteristics in Pennsylvania between 2018 and 2020, and before and after the onset of the COVID-19 pandemic.Method: We used the 2018-2021 Pennsylvania Opioid Overdose Information Network data, which include information on overdose incidents in Pennsylvania that require emergency response. We performed multilevel negative binomial regressions to measure individual and county-level differences in overdose rates, controlling for differences by year.Results: At the state level, there were no significant changes in overdose incident rates by year, but 11 counties experienced significant rate increases 2018-19 to 2020-21. Black individuals demonstrated a nine times higher incident rate than White individuals. Additionally, people living in counties with higher educational attainment, higher poverty, and higher population density had lower overdose incident rates than their counterparts. Conclusions: The synthetic opioid overdose rate has accelerated since the onset of the COVID-19 pandemic, but this trend varies across counties. Particular attention should be paid to the counties with significant increases since the onset of the COVID-19 pandemic in 2020, and more local and regional analyses are required to understand community needs in the face of the ongoing opioid epidemic.