Severe floods were linked to lasting increases in opioid overdose deaths in rural Appalachia

Severe flooding may have effects on opioid overdose deaths that continue long after floodwaters recede, according to a study published in the Proceedings of the National Academy of Sciences.

The researchers examined county-level opioid overdose death data from the National Center for Health Statistics, presidential disaster declarations from the Federal Emergency Management Agency, and severe storm data from the National Oceanic and Atmospheric Administration. They focused on severe floods in rural Appalachia.

The study found a significant increase in county-level opioid overdose mortality after severe floods. According to the abstract, that increase persisted for a decade after flooding. The supplied study record does not report the size of the increase, the number of counties or flood events analyzed, or other statistical details.

The research also included interviews with 17 stakeholders about the floods that struck Eastern Kentucky in July 2022. These were retrospective interviews, meaning people were asked to look back on events after they happened.

Interview participants described several ways a disaster could make recovery harder. Flooding may reduce access to treatment, recovery support and harm-reduction services, which are services intended to reduce the risks linked with drug use. Participants also described trauma, instability and ongoing stigma around seeking help.

Those interview findings help explain a possible pathway between flooding and overdose deaths, but they do not measure how often each problem occurred or prove that any one factor caused an overdose. The interview group was also small and focused on one flood event in Eastern Kentucky.

The broader analysis is observational. It compares patterns in real-world data rather than assigning places to experience a flood or not experience one. That means the study can identify a strong association over time, but it cannot fully rule out other changes that may have affected overdose mortality in those counties.

Still, the findings suggest that disaster planning may need to consider continuity of support for people affected by opioid use disorder and for communities already facing overdose harms. The study’s authors say understanding these effects is important as severe disasters are expected to continue.

More research would need to report the size of the risk in different places, test whether the same pattern appears outside rural Appalachia, and examine which disaster-response supports best protect access to care and recovery services after flooding.