Age, Period, and Cohort Patterns in the Use of Drugs with Elevated Overdose Risk in the United States, 1979-2018

摘要: The United States has experienced four decades of increases in drug overdose deaths (National Institute on Drug Abuse [NIDA], 2020a; Jalal et al., 2018). All told, estimates suggest that drug overdoses have directly led to the deaths of 700,000 Americans since 1980 (Hedegaard, et al., 2020; Jalal et al., 2018). Because they comprise the largest share of overdoses over the past several decades (Hedegaard et al., 2020), there is substantial popular and scholarly attention to opioids’ role in shaping these patterns, including certain prescription pain relievers, heroin, and fentanyl. However, overdoses involving other drugs, including benzodiazepines, powder and crack cocaine, and methamphetamine, also increased dramatically over this period (Hedegaard et al.,, 2020) and currently more than half of drug overdoses involve multiple substances (Gladden et al., 2019). These patterns have contributed to rising middle age mortality in the United States (Case and Deaton, 2015; Ho and Hendi, 2018; Masters et al., 2018; Monnat, 2020; Woolf et al., 2018).Canonical explanations of increasing overdose mortality in the United States focus on both supply-side and demand-side factors. Supply-side factors include changes in the supply of certain drugs relative to others (eg, the surge in opioid prescribing in the late 1990s and 2000s), the rise of abuse deterrent formulations of some prescription opioids that lead people to non-regulated drugs, and accidental and intentional fentanyl contamination (Centers for Disease Control and Prevention [CDC], 2019; Ciccarone, 2019; Dasgupta et al., 2018; McLean et al., 2019; Ruhm 2018). Demand-side factors include …