LAUSR

Objective : To compare the mortality risk due to covid-19 with death due to overdose in British Columbia, Canada. The opioid epidemic was declared a public health emergency in 2016. Methods : Mortality risk was calculated in micromorts with covid-19 data for January–October 2020, derived from the BC Centre for Disease Control, and illicit drug toxicity deaths for January 2010–September 2020, derived from the BC Coroners Service. Age-stratified covid-19 incidence and deaths per 100,000 and age-stratified illicit drug toxicity death rates per 100,000 were calculated. A micromort is a unit of risk equivalent to a one-in-a-million chance of death. Results : During the covid-19 pandemic, illicit drug toxicity deaths reached 1.0 micromorts per day, representing an increase of 0.5 micromorts per day relative to 2019 rates. In comparison, covid-19 mortality risk was 0.05 micromorts per day among individuals from the general population living in British Columbia and 21.1 micromorts per day among those infected with covid-19. Covid-related mortality risk was significantly lower among individuals aged <60 years, relative to older adults, whereas drug toxicity-related mortality was highest for individuals aged 30–59 years. Conclusions : The mortality associated with covid-19 is apparent and distributed unevenly across subpopulations. The mortality due to overdose has increased during covid-19 and exceeds mortality due to covid-19. Our results instantiate the triple threat caused by covid-19 (i.e., the public health crisis, economic crisis and mental health crisis) and quantitatively highlight the externality of increased mortality due to deaths of despair in response to public health efforts to reduce covid-related mortality.