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We measured whether the associations of prescription opioid supply with drug overdose deaths vary by local socio\u2010economic conditions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Ecological county\u2010level study, including 3109 US counties between 2006 and 2019 (<jats:italic>n<\/jats:italic>\u2009=\u200943\u2009526 county\u2010years) using annual mortality data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>United States.<\/jats:p><\/jats:sec><jats:sec><jats:title>Cases<\/jats:title><jats:p>A total of 711\u2009447 drug overdose deaths.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>We modeled overdose counts using Bayesian hierarchical Poisson models, estimating associations between four types of drug overdose deaths (deaths involving any drugs, any opioid, prescription opioids only and heroin), prescription opioid supply and five socio\u2010economic indicators: unemployment, poverty rate, income inequality, Rey index (components include mean household income, % high school graduates, % blue\u2010collar workers and unemployment rate), and American human development index (HDI; an indicator of community wellbeing).<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>Drug overdose deaths and all substance\u2010specific overdose deaths were higher in counties with higher income inequality [adjusted odds ratios (aORs)\u2009=\u20091.09\u20131.13], Rey index (aORs\u2009=\u20091.15\u20131.21) and prescription opioid supply (aORs\u2009=\u20091.14\u20131.21), and lower in counties with higher HDI scores (aORs\u2009=\u20090.75\u20130.92). Poverty rate, income inequality and HDI scores were found to modify the effect of prescription opioid supply on heroin overdose deaths. The plot of the interactions showed that when disadvantage is high, increasing prescription opioid supply does not increase heroin overdose deaths. The less disadvantage there is, indicated by lower poverty rates, higher HDI scores and lower income inequality, the greater the effect of increasing prescription opioid supply relative to population size on heroin overdose deaths in US counties.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In the United States, prescription opioid supply is associated with higher drug overdose deaths; associations are stronger in counties with less disadvantage and less income inequality, but only for heroin overdose deaths.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.16123","type":"journal-article","created":{"date-parts":[[2023,1,6]],"date-time":"2023-01-06T10:59:28Z","timestamp":1673002768000},"page":"1072-1082","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Understanding the differential effect of local socio\u2010economic conditions on the relation between prescription opioid supply and drug overdose deaths in US counties"],"prefix":"10.1111","volume":"118","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1531-1525","authenticated-orcid":false,"given":"David S.","family":"Fink","sequence":"first","affiliation":[{"name":"New York State Psychiatric Institute New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5624-021X","authenticated-orcid":false,"given":"Katherine M.","family":"Keyes","sequence":"additional","affiliation":[{"name":"Columbia University Mailman School of Public Health New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Branas","sequence":"additional","affiliation":[{"name":"Columbia University Mailman School of Public Health New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8441-7046","authenticated-orcid":false,"given":"Magdalena","family":"Cerd\u00e1","sequence":"additional","affiliation":[{"name":"Department of Population Health New York University New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0474-9524","authenticated-orcid":false,"given":"Paul","family":"Gruenwald","sequence":"additional","affiliation":[{"name":"Prevention Research Centre Pacific Institute for Research and Evaluation Berkeley CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6533-7021","authenticated-orcid":false,"given":"Deborah","family":"Hasin","sequence":"additional","affiliation":[{"name":"New York State Psychiatric Institute New York NY USA"},{"name":"Columbia University Mailman School of Public Health New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,1,26]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"crossref","unstructured":"HedegaardH MininoAM WarnerM.Drug overdose deaths in the United States 1999\u20132018.2020. 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