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Increased Risk of Opioid Overdose Death Following Cold Weather

A Case–Crossover Study

Goedel, William C.a; Marshall, Brandon D. L.a; Spangler, Keith R.a,b,c; Alexander-Scott, Nicoled; Green, Traci C.a,e,f,g; Wellenius, Gregory A.a,b; Weinberger, Kate R.a,b

doi: 10.1097/EDE.0000000000001041
Environmental Epidemiology

Background: The United States is in the midst of an opioid overdose crisis. Little is known about the role of environmental factors in increasing risk of fatal opioid overdose.

Methods: We conducted a case–crossover analysis of 3,275 opioid overdose deaths recorded in Connecticut and Rhode Island in 2014–2017. We compared the mean ambient temperature on the day of death, as well as average temperature up to 14 days before death, to referent periods matched on year, month, and day of week.

Results: Low average temperatures over the 3–7 days before death were associated with higher odds of fatal opioid overdose. Relative to 11°C, an average temperature of 0°C over the 7 days before death was associated with a 30% higher odds of death (odds ratio: 1.3; 95% confidence interval, 1.1, 1.5).

Conclusions: Low average temperature may be associated with higher risk of death due to opioid overdose.

From the aDepartment of Epidemiology, School of Public Health, Brown University Providence, RI

bInstitute at Brown for Environment and Society, Brown University, Providence, RI

cDepartment of Earth, Environmental, and Planetary Sciences, Brown University, Providence, RI

dRhode Island Department of Health, Providence, RI

eDepartment of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI

fDepartment of Medicine, Warren Alpert Medical School, Brown University, Providence, RI

gDepartment of Emergency Medicine, School of Medicine, Boston University, Boston, MA.

Submitted October 14, 2018; accepted May 21, 2019.

Supported in part by a cooperative agreement between the National Center for Injury Prevention and Control and the Rhode Island Department of Health (U17CE002740; Principal Investigator: Jan Shedd, MEd). Dr. Weinberger is supported by a grant from the National Institute of Environmental Health Sciences (F32ES027742). Dr. Marshall is supported by a grant from the National Institute of General Medical Sciences (P20GM125507). Mr. Goedel is supported by the Brown University Clinical and Community-Based HIV/AIDS Research Training Fellowship funded by the National Institute of Mental Health (R25MH083620).

The authors report no conflicts of interest.

Supplemental digital content is available through direct URL citations in the HTML and PDF versions of this article (

Data Access: Given the sensitive nature of overdose deaths, the raw data used in this study on accidental drug-related deaths in Rhode Island cannot be made available. However, the raw data on accidental drug-related deaths in Connecticut is available online in the public domain from the Office of the Chief Medical Examiner. The raw data on ambient temperature is available online in the public domain from the PRISM Climate Group of Oregon State University. All R code used to generate the case–crossover dataset and fit the conditional logistic regression models are available in the Digital Repository of Brown University.

Correspondence: Brandon D. L. Marshall, Brown University School of Public Health, Department of Epidemiology, 121 South Main Street, Box G-S121-2, Providence, RI 02912. E-mail:

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