When Crises Collide: The Looming Threat of Climate Change on Opioid Users

Experts warn of a “perfect storm” where climate change and opioid use disorders intersect, creating heightened risks and challenges.


In an article that connects two major public health crises, researchers from the University of California, Berkeley, revealed that climate change could have dire implications for people with opioid use disorders. The study, published in the Journal of Addiction Medicine, serves as a clarion call to address the “looming confrontation between the world’s complex overdose crisis and its equally intensifying climate emergency.”

The study, led by Jerel M. Ezell from the University of California, Berkeley School of Public Health Community Health Sciences, posits that the vulnerabilities associated with opioid use disorders are exacerbated by the consequences of climate change, particularly among those with low socioeconomic status. This is the first scholarly work to explore the structural and social determinants of climate change vulnerability among people who use drugs (PWUDs), especially those with opioid addiction.

“The United States and countries in the West will not be spared, demonstrating the wide reach of the climate emergency, which is increasingly resistant to nations’ economic and infrastructural advantages and now hints at a dramatic widening in social and health disparities,” Ezell writes. 
“Along these lines, the opioid and polydrug use epidemic is poised to peak just as some of climate change’s most severe effects begin to unfold, potentially forming a highly aggressive and persistent climate injustice.”

California recently underwent a nearly unprecedented experience: a tropical storm that almost made landfall as a hurricane. A question that arose during the event was how the rare storm on California’s coast was connected to climate change. Researchers have stated that the number and intensity of storms would grow as global temperature increases.

While it cannot yet be directly tied to climate change, as this was still a singular event, what did make the event more difficult for California was not necessarily the storm itself, as much as the lack of infrastructure built to deal with hurricanes and tropical storms. If Hilary is but the vanguard of a more significant problem, the area may have to deal with hurricanes, the recent droughts, and other recent emergencies the area has experienced (an earthquake shook this same region at the end of the storm was passing overhead).

Climate change is creating many questions about the future of human society and how we will deal with its impacts. Of course, we do not yet know what effects will take place, if we will be able to cap warming, or how we may (or may not) be able to adapt to the changes. No matter what, the global emergency will create upheaval, and it will, as things tend to do, affect those who are already suffering the most acutely.

Questions have been raised regarding the links between climate change and mental health, and some researchers are starting to ask about specific mental health issues, such as addiction. While the United States is already dealing with an overdose crisis, some question how climate change will morph and possibly increase this devastating issue.

For example, California has seen a jump in overdose deaths over the past three full calendar years:

If they start facing these storms regularly, how will that impact this growing epidemic?

Ezell attempts to make the connections between climate change and the overdose epidemic. Specifically, who will be most impacted, what those impacts will be, and how we can start preparing for these issues now. While recent reports from the IPCC (Intergovernmental Panel on Climate Change) have identified those in the global south as at most risk from climate change, the northern nations are not out of the woods.

Ever since the COVID-19 pandemic, the overdose crisis has continued to worsen. “There was a staggering 32% increase in opioid overdose deaths in the United States in 2020, the pandemic’s start, from 2019, and the trajectory has not yet leveled.” In addition to the socioeconomic disenfranchisement that many people who use drugs (PWUD) experience, there has been an increase in social isolation since the pandemic, which has also been multiplied by limited access to healthcare and harm reduction services. As seen in Kensington near Philadelphia, the nation’s largest open-air drug market, the street opioid supply has been completely overwhelmed by synthetic fentanyl and other derivatives.

“Framing these converging forces as symbiotic, it can be said that a similarly perfect storm will emerge as climate change further limits communities’ health-promoting outlets and resources, particularly for those living in areas that are already socioeconomically distressed and thus socioeconomically vulnerable.”

Just the increase in temperatures, which has been seen over the past summer, may create an increase in overdose deaths by itself. “…taking opioids during extreme heat can create a strong, synergistically sedative effect and cultivate impurities, potentially elevating the likelihood of overdose. In addition, use of stimulants such as cocaine can significantly increase one’s body temperature, a dynamic that could be accelerated during outdoor drug use and contribute to ‘overamping.’” There are also issues of how climate change will affect the global drug supply chain. Interruptions to the chain have also been shown to increase overdoses.

To help preemptively combat these issues, Ezell calls for an increase in harm reduction services, including drug treatment such as medication-assisted therapy (buprenorphine, suboxone, methadone, etc.) “…there must be enhanced support and funding for harm reduction services and treatment for PWUDs, particularly for Black, Native American, and Latino drug-using communities, where access to crucial resources such as syringe services programs, naloxone, and buprenorphine frequently lags.” The multiplying difficulties will have disproportionate effects on these communities. Without the tools to combat what Dr. Ezell sees as a “surge” in use and associated problems, the number of overdose deaths will skyrocket.

Ezell also calls for the United States (if not the greater world itself) to move away from the “Drug War” approach to addiction and illicit drug use, where drugs are criminalized, and policies are built to be demonstrably prohibitive and punitive, towards a policy foundation built on support, acceptance, and recovery. This would include education for PWUD on the causes of climate change, the impacts of climate change, and how climate change will cause difficulties for them specifically.

“…it is crucial that PWUDs are educated on safer ways to use drugs according to certain climatological thresholds (e.g., limiting usage to cool, indoor settings during hot weather). Along these lines, providers can further help PWUDs identify specific social determinants of climate change vulnerability that they face given their job housing and food security, and so forth.”

The climate crisis has yet to take hold fully, and we are already scrambling to identify who will be most affected and how. Connections between the disparities that people face in socioeconomic terms and the system at work driving global climate change have been made for some time. For PWUD, “one of the most powerful solutions for dealing with matters of life and death is empowering those directly confronted with it to better conceptualize, contextualize, and navigate the risks.”

While harm reduction psychoeducation can help do just that, there are gaps in knowledge that additional philosophical shifts may assist with. Specifically, a critical approach to psychology, which moves away from an individualized, competitive, reductive stance on human nature and analyzes how social and political impacts drive human experience,  may help create the necessary understanding of the situation people will need to fully understand how to defend against climate change.

A critical psychological approach moves the questions beyond personal choices and, in this instance, would ask how social forces are driving addiction and drug use patterns and how those patterns are connected to the “Capitalocene.” In doing so, the connections between climate change, capitalism, and the overdose crisis would become more apparent, leading to the broader acceptance of solutions beyond the individual level.



Ezell, J. M. (2023). Climate Change and the Opioid Epidemic. Journal of Addiction Medicine, 10-1097. (Link)



    • Did you read the whole section in the article that mentions that COVID-19 is a strong exemplar of how the opioid epidemic can be amplified by an adjoining environmental health crisis? Also, the surges and disparities in opioid use/overdose have not really subsided post-COVID.

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