Increasing burden of opioid overdose mortality in the United States: Years of life lost by age, race, and state from 2019-2021

The United States’ opioid crisis is worsening, but the nationwide burden has not been characterized during the COVID-19 pandemic. In this study we calculate years of life lost to opioid overdose deaths by demographic group and examine trends from 2019 to 2021. Using the Multiple Cause of Death dataset from CDC WONDER, we extracted opioid overdose deaths stratified by race/ethnicity, age, and state, and estimated crude and age-adjusted mortality rates, years of life lost, and reduction in life expectancy at birth. Increasing annually, opioid overdose deaths reached 80,411 in 2021, leading to 3 million years of life lost, and reducing life expectancy by 0.65 years. From 2019 to 2021, opioid overdose death rates increased across all groups. American Indian/Alaska Native and Black/African American men now experience the highest burden, with 1,500 years of life lost per 100,000, life expectancies at birth reduced by almost 1 year, and 46 and 51 deaths per 100,000, respectively. This study highlights the continued growth of the opioid crisis, and the surge in years of life lost coinciding with COVID-19. There is an urgent need for more effective interventions, particularly in light of this epidemic’s changing demographics. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study used ONLY openly available human data that were originally located at: and I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Our code is open access on GitHub: All data produced in the present study are available upon reasonable request to the authors, and are available online at: