Friedman J, Mann NC, Hansen H, et al. - Records from the national emergency medical services (EMS) database are identified as an effective tool to rapidly surveil shifts in US overdose mortality. During the pandemic, there were unprecedented overdose deaths that highlighted the necessity for investments in overdose prevention as a critical aspect of the COVID-19 response and post pandemic recovery. Socioeconomically disadvantaged and racial/ethnic minority communities bore more compounded burden of disproportionate COVID-19 mortality and rising overdose deaths.

• This cohort study included 83.7 million EMS patient encounters.

• Nearly 40% rise in overdose-associated cardiac arrests occurred nationally in 2020.

• Latinx individuals (49.7%) and Black or African American individuals (50.3%), people living in more impoverished neighborhoods (46.4%), and the Pacific states (63.8%) exhibited the largest percentage increases.

• There was high concordance with provisional total overdose death figures through July 2020.