How Did States’ COVID-19 Mitigation Policies Affect Drug Overdoses and Suicides in the United States?

During the COVID-19 pandemic, U.S. states enacted physical distancing policies (e.g., stay-at-home orders, business closures) to reduce the spread of COVID-19. There was speculation that these policies could adversely affect mental health and increase drug overdose risk. To mitigate the adverse effects of the pandemic and its restrictive policies, many states also enacted economic supports, such as direct cash payments and eviction moratoria. States varied in both the implementation and duration of their physical distancing and economic support policies. Using mortality data from the U.S. National Vital Statistics System and state policy indices from the Oxford COVID-19 Government Response Tracker, we identified associations between states’ COVID-19 policies and fatal drug overdose and suicide rates among U.S. working-age adults (ages 25-64). In terms of drug overdoses, state physical distancing policies significantly increased, while economic support policies significantly reduced overdose rates. A one-unit increase in physical distancing policy strength predicted a 15% average monthly increase in county-level overdose rates for males (IRR=1.15, 95% CI=1.09, 1.20) and a 14% increase for females (IRR=1.14, CI=1.09, 1.20). A one-unit increase in economic support policy strength predicted a 3% average monthly decline for males (IRR=0.93, CI=0.95, 1.00) and a 4% decline for females (IRR=0.96, CI=0.93, 0.99). Ultimately, the economic supports that states enacted were insufficient to fully mitigate the adverse relationship between activity limitations and drug overdoses. In terms of suicides, a ten-unit increase in physical distancing policy strength was associated with a decrease of 0.065 (95% CI=-0.101, -0.036) in the state-level male suicide rate. This decrease was concentrated in reductions in firearm suicides. There was no association for females. The economic support index was negatively associated with the suicide rate for males only in 2022 (-0.031 95% CI -0.064, -0.010). These findings contribute to understanding unintended consequences of pandemic mitigation policies in the United States.