Higher unemployment benefits are associated with reduced drug overdose mortality in the United States before and during the COVID-19 pandemic

Abstract

ObjectivesOverdose mortality rates in the United States remain critical to population health. Economic , such as unemployment, are noted risk factors for drug overdoses. The COVID-19 pandemic exacerbated economic hardship; as a result, the US government enacted income protection programs in conjunction with existing unemployment insurance (UI) to dampen COVID-19-related economic consequences. We investigate whether UI, operationalized as the weekly benefit allowance (WBA) replacement rate, is negatively associated with drug-related overdoses. MethodsData from the pooled 2014–2020 Detailed Restricted Mortality files for all counties from the Centers for Disease Control and Prevention, restricted to people ≥18 years of age, aggregated at the county-quarter level (n = 89,914). We included any fatal drug, opioid, and stimulant overdose. We modeled the association between WBA replacement rate (e.g., a greater proportion of weekly earnings replaced by UI) on each county-level age-adjusted mortality outcome using separate linear regression models during 2014–2020, pre-COVID (2014–2018), and post-COVID (2019-2020). We conducted sensitivity analyses using multi-level linear regression models. ResultsResults indicated that a more robust WBA replacement rate any drug (Risk Difference [RD]: −0.06, 95 % Confidence Interval [CI]: −0.08, −0.05), opioid (RD: −0.04, 95 % CI: −0.06, −0.03), and stimulant (RD: −0.03, 95 % CI: −0.04, −0.02) across the entire study period (2014–2020). A more robust WBA replacement rate was associated with fewer fatal drug, opioid and stimulant overdoses in the pre-COVID-19 period and on fatal any drug and stimulant overdoses in the COVID-19 period. ConclusionsFindings support the notion that income protection policies, such as robust UI, can have a supportive role in preventing fatal drug overdoses, calling for a broader discussion onthe role of the safety net programs to buffer drug-related harms.