{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T23:50:06Z","timestamp":1786578606964,"version":"build-2736575974"},"reference-count":42,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T00:00:00Z","timestamp":1759708800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["DP2 DA049282"],"award-info":[{"award-number":["DP2 DA049282"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["R37DA15612"],"award-info":[{"award-number":["R37DA15612"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and aims<\/jats:title>\n                    <jats:p>Understanding the relationship between heat and drug overdose mortality is critical given the ongoing overdose crisis and rising global temperatures driven by climate change. Evidence from local jurisdictions in the United States (US) and Canada indicates that exposure to heat is associated with increased drug overdose fatalities, but the widespread impact of heat on national drug overdose deaths is undetermined. We aimed to determine the effect of heat exposure on drug overdose mortality in the US.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>An observational study using monthly, county\u2010level data from 1999 to 2020 and a fixed effect model estimated with linear regression. The model accounts for time\u2010invariant county\u2010month factors and state\u2010level time\u2010specific shocks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>All counties in the continental US during the months of June to September from 1999 to 2020.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Decedents in the National Center for Health Statistics restricted Vital Statistics mortality data with a cause of death of a drug overdose, aggregated to county\u2010level mortality rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>All drug overdose mortality rate per 100\u2009000 population. The monthly average maximum heat index (measured in degrees Celsius) was collected from the Centers for Disease Control and Prevention National Environmental Public Health Tracking Network.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>\n                      A one\u2010degree Celsius increase in the heat index was associated with an increase in all drug overdose mortality by 0.0098 deaths per 100\u2009000 population [95% confidence interval (CI) = 0.0057\u20130.014,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001], with significant effects for deaths related to opioids (0.0060 deaths, 95% CI = 0.0026\u20130.0095,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001), cocaine (0.0028 deaths, 95% CI = 0.0012\u20130.0045,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001) and psychostimulants (0.0028 deaths, 95% CI = 0.0015\u20130.0041,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). In further analyses, larger impacts were observed after 2013, in counties with greater levels of social vulnerability and in suburban and urban counties. Estimates suggest that approximately 150 excess drug overdose deaths occurred per year during the hottest periods due to heat exposure.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Exposure to heat appears to be associated with increases in drug overdose deaths in the United States in recent decades.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.70191","type":"journal-article","created":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T23:32:10Z","timestamp":1759793530000},"page":"275-285","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Heat exposure and drug overdose mortality in the USA"],"prefix":"10.1111","volume":"121","author":[{"given":"Julia M.","family":"Dennett","sequence":"first","affiliation":[{"name":"Department of Epidemiology of Microbial Diseases Yale School of Public Health  New Haven CT USA"},{"name":"Digital Health Research Cluster Hasso Plattner Institute  Potsdam Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Carri\u00f3n","sequence":"additional","affiliation":[{"name":"Department of Environmental Health Sciences Yale School of Public Health  New Haven CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4006-010X","authenticated-orcid":false,"given":"David A.","family":"Fiellin","sequence":"additional","affiliation":[{"name":"Departments of Medicine, Emergency Medicine, Health Policy and Management Yale Schools of Medicine and Public Health  New Haven CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5789-9841","authenticated-orcid":false,"given":"Gregg S.","family":"Gonsalves","sequence":"additional","affiliation":[{"name":"Department of Epidemiology of Microbial Diseases Yale School of Public Health  New Haven CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,6]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"IPCC.Summary for Policymakers. In:Climate Change2023. Synthesis Report. In: Core Writing Team HLaJRe editor. Contribution of Working Groups I II and III to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change Geneva Switzerland: IPCC; 2023 1\u201334"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1257\/jel.52.3.740"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.12957"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41558-018-0222-x"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2542-5196(22)00117-6"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0b013e3181ad5522"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2542-5196(21)00210-2"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pharmthera.2014.05.001"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-136-11-200206040-00006"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1353\/hpu.2022.0092"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1360-0443.1999.9479612.x"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.940569"},{"key":"e_1_2_10_14_1","unstructured":"United States Environmental Protection Agency.Climate Change and Extreme Heat: What You Can Do to Prepare. EPA October2016."},{"key":"e_1_2_10_15_1","unstructured":"National Integrated Heat Health Information System.Who Is Most At Risk To Extreme Heat?https:\/\/www.heat.gov\/pages\/who-is-at-risk-to-extreme-heat"},{"key":"e_1_2_10_16_1","unstructured":"National Institute on Drug Abuse.Drug Overdose Death RatesGaithersburg MD: National Institute on Drug Abuse; [updated May 14 2024 July 11 2024].https:\/\/nida.nih.gov\/research-topics\/trends-statistics\/overdose-death-rates"},{"key":"e_1_2_10_17_1","doi-asserted-by":"crossref","unstructured":"GarnettMF Mini\u00f1oAM.Drug Overdose Deaths in the United States 2003\u20132023. NCHS Data Brief2024;No. 522","DOI":"10.15620\/cdc\/170565"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2017.04.019"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2009.02887.x"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.279.22.1795"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.9778\/cmajo.20210291"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.envint.2023.108233"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.alcohol.2021.04.001"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1038\/s43856-023-00346-1"},{"key":"e_1_2_10_25_1","unstructured":"BurkeM ZahidM MartinsMC CallahanC LeeRAvirmedTet al.Are We Adapting to Climate Change? National Bureau of Economic Research Working Paper Series.2024; No. 32985"},{"key":"e_1_2_10_26_1","unstructured":"Centers for Disease Control and Prevention.National Environmental Public Health Tracking Network2024[updated May 31 2023 January 2 2024].https:\/\/ephtracking.cdc.gov\/indicatorPages?selectedContentAreaAbbreviation=35&selectedIndicatorId=173"},{"key":"e_1_2_10_27_1","unstructured":"National Weather Service National Oceanic and Atmospheric Administration.2024.What is the heat index?https:\/\/www.weather.gov\/ama\/heatindex"},{"key":"e_1_2_10_28_1","unstructured":"National Center for Health Statistics.Restricted\u2010Use Vital Statistics Data \u2010 multiple cause of death 1999\u20132000 as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Centers for Disease Control and Prevention."},{"key":"e_1_2_10_29_1","unstructured":"AhmadF CisewskiJ RossenL SuttonP.Provisional drug overdose death counts: National Center for Health Statistics;2023[updated January 17 2024. January 25 2024].https:\/\/www.cdc.gov\/nchs\/nvss\/vsrr\/drug-overdose-data.htm"},{"key":"e_1_2_10_30_1","unstructured":"Surveillance Epidemiology and End Results Program.2023.Download U.S. County Population Data \u2010 1969\u20102020: National Cancer Institute; 2023 [March 20 2023].https:\/\/seer.cancer.gov\/popdata\/download.html"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1289\/EHP14677"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.envint.2023.108005"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2024.5134"},{"key":"e_1_2_10_34_1","unstructured":"Centers for Disease Control and Prevention.Rising Numbers of Deaths Involving Fentanyl and Fentanyl Analogs Including Carfentanil and Increased Usage and Mixing with Non\u2010opioids 2018[updated July 11 2018 May 27 2024]. CDCHAN\u201000413."},{"key":"e_1_2_10_35_1","doi-asserted-by":"crossref","unstructured":"SpencerMR GarnettMF Mini\u00f1oAM.Urban\u2013Rural Differences in Drug Overdose Death Rates 2020. Hyattsville MD: National Center for Health Statistics; 2022 [updated July 21 2022 May 27 2024].https:\/\/doi.org\/10.15620\/cdc:118601","DOI":"10.15620\/cdc:118601"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0227966"},{"key":"e_1_2_10_37_1","unstructured":"Maricopa County Department of Public Health.2022Heat Deaths Report. In: DoEa Informatics editor. 2023."},{"key":"e_1_2_10_38_1","unstructured":"MacleanJC MallattJ RuhmCJ SimonK.Economic Studies on the Opioid Crisis: A Review. National Bureau of Economic Research Working Paper Series2020; No. 28067"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2021.4369"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0000000000001041"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.1029\/2022GH000695"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)01209-5"},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7315a1"}],"container-title":["Addiction"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/add.70191","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T04:15:34Z","timestamp":1767845734000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/add.70191"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,6]]},"references-count":42,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1111\/add.70191"],"URL":"https:\/\/doi.org\/10.1111\/add.70191","archive":["Portico"],"relation":{},"ISSN":["0965-2140","1360-0443"],"issn-type":[{"value":"0965-2140","type":"print"},{"value":"1360-0443","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,6]]},"assertion":[{"value":"2025-02-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-06","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}