Date of Award

January 2024

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Daniel Carrión

Second Advisor

Julia Dennett


Background: The opioid crisis and climate change are two severe public health crises. There may be a synergistic relationship between the two, as extreme temperatures events (both hot and cold) may alter behavior and cause physiological stress that makes fatal opioid overdose more likely. Methods: We analyze the association between fatal opioid overdose and extreme temperature exposure using a case-crossover design and a distributed lag non-linear model, which allows us to look at the odds of death 0-6 days after temperature exposure. We used death records from North Carolina and daily county-level temperature exposures. The analyses were conducted on data spanning the opioid crisis (2000-2022) and in “waves” (Wave One: 2000-2011; Wave Two: 2012-2022), to capture the differences in effects as the opioid crisis progressed and shifted from primarily prescription drug abuse to illicit drug abuse. Results: We found that extreme temperature exposures are associated with increased odds of fatal opioid overdose, with the most significant impact observed at a two-day lag – meaning the death occurred two days after the exposure. This effect applies to both extreme heat and extreme cold, and this association is most pronounced during Wave Two of the opioid crisis (2012-2022). Counties with high social vulnerability show stronger association between extreme temperature and fatal opioid overdose as the crisis progresses from Wave One to Wave Two, while counties with low social vulnerability exhibit the opposite trend. Conclusion: This work highlights how extreme temperature events are associated with increased odds of fatal opioid overdose and that this association is becoming stronger as the opioid crisis progresses. Enhanced awareness of this and public health interventions during and after extreme temperature events could help mitigate these effects.


This is an Open Access Thesis.

Open Access

This Article is Open Access