Characteristics and Circumstances of US Overdose Deaths With Recorded Heat Involvement.

OBJECTIVES: To examine the extent to which heat-related causes of death are recorded in fatal drug overdoses, how these patterns vary across states and over time, and how overdose characteristics differ between deaths with, versus without, heat involvement recorded. METHODS: Death certificate data (from the National Center for Health Statistics) for all drug overdose deaths in US residents, 2001-2024, were analyzed to identify whether a heat-related cause of death was also listed on the death certificate. Joinpoint regression, descriptive statistics, and nonparametric tests were used to examine temporal trends and compare overdose deaths with versus without recorded heat involvement. RESULTS: In 2001, fewer than 10 drug overdose deaths with recorded heat involvement were identified, but this number rose to 558 in 2024. Mortality rates for overdoses with recorded heat involvement increased from 2013 to 2024 with an estimated annual percent change of 30.1 (95% confidence interval, 26.5-47.1); the highest mortality rates and numbers of deaths were observed in residents of Arizona and Nevada. American Indian/Alaska Native, Mexican-heritage, and foreign-born populations accounted for larger shares of overdose deaths with, compared with without, heat involvement recorded. A street or highway was more frequently identified as the place of injury in overdose deaths with (18.9%), versus without (2.2%) heat involvement reported. Psychostimulants such as methamphetamine were involved in 85.9% of overdose deaths with, versus 28.9% without, recorded heat involvement. CONCLUSIONS: Although representing only a fraction of all overdose deaths, fatal overdoses with recorded heat involvement have increased, disproportionately impacting certain states and demographic groups.