Objective: Given increases in opioid overdose rates, and policy changes expanding access to medications for OUD, during the COVID-19 pandemic, we sought to understand how the opioid overdose epidemic impacted veterans with opioid use disorder (OUD), from 2016 to 2021.

Method: We examined the prevalence and trends in opioid overdose deaths, and age at death, from 2016 to 2021, by sex and race/ethnicity among veterans with OUD enrolled in the Veterans Health Administration (VHA). We calculated the multiplicative and additive interactions between sex and age, and opioid overdose death.

Results: 203,950 veterans enrolled in VHA from 2016 to 2021 had an OUD; 16 % (n = 32,640) died during this period. Opioid overdose contributed to 17.42 % (n = 5686) of all deaths. Although the total number of overdose deaths rose each year, the relative risk of dying from an opioid overdose decreased. Of those who died, veterans, ages 18-29 were significantly more likely to die of an opioid overdose than veterans over the age of 40. Female veterans were significantly more likely to die from an opioid overdose, with this risk manifesting significantly earlier and faster when compared to male veterans of the same age. Black and Asian veterans were significantly more likely to die by opioid overdose than White veterans.

Conclusions: Despite an overall decrease in relative risk of opioid overdose death during the first two years of the COVID-19 pandemic (2020-2021) there was a significant increase in risk of opioid overdose death among female and racial and ethnic minority veterans with OUD.