Friday, March 4, 2022

Study Examines Shifting Racial Trends in Drug Overdose Deaths

Drug overdose death rates among Black people living in the United States rose significantly from 2019 to 2020, outpacing the overdose death rates of White people for the first time in over 20 years, according to a report published this week in JAMA Psychiatry. The analysis also revealed that American Indian or Alaska Native people experienced the highest rate of overdose mortality in 2020 of all the groups examined.

“Recent studies suggest that an increasingly toxic illicit drug supply, characterized by polysubstance use of potent synthetic opioids and benzodiazepines as well as high-purity methamphetamine, is contributing to worsening of the U.S. overdose crisis,” wrote Joseph R. Friedman, M.P.H., and Helena Hansen, M.D., Ph.D., of the University of California, Los Angeles. “The high—and unpredictably variable—potency of the illicit drug supply may be disproportionately harming racial and ethnic minoritized communities, with deep-seated inequalities in living conditions (including stable housing and employment, policing and arrests, preventive care, harm reduction, telehealth, medications for opioid use disorder, and naloxone access) likely playing a role.”

Friedman and Hansen relied on data from the Centers for Disease Control and Prevention (CDC) Wide-Ranging Online Data for Epidemiologic Research (WONDER) platform and the National Center for Health Statistics (NCHS) to calculate drug overdose death rates per 100,000 people by race and ethnicity for 1999 to 2020. 

For all racial and ethnic groups assessed, the relative increases in drug overdose mortality rates between 2019 and 2020 were higher than any prior year-to-year increase going back to 1999. Among Black people, drug overdose death rates per 100,000 increased by nearly 50%—from 24.7 in 2019 to 36.8 in 2020—surpassing the overdose death rates for White people (31.6 per 100,000 in 2020) for the first time since 1999. “This is a reversal of the overdose mortality gap among Black and White individuals noted in 2010, when the rate per 100,000 among White individuals (15.8) was double … that seen among Black individuals (7.9),” the authors wrote.

Compared with the other groups, American Indian or Alaska Native people had the highest death rates from drug overdose in 2020 (41.4 per 100,000). Although the data revealed that Hispanic or Latino people had the lowest drug overdose death rates in 2020 (17.3 per 100,000), the authors noted this population experienced a 40.1% increase in drug overdose rates from 2019 to 2020.

In the February issue of the American Journal of Psychiatry, Friedman and colleagues reported similar findings from their analysis of records from CDC WONDER on drug-related overdose mortality per 100,000 people: Overdose mortality per capita among Black people more than tripled between 2010 and 2019, compared with a 58% increase among White people during the same period examined. The authors noted that in 2010, Black people had an overdose mortality rate that was about half that of White people; by 2019, however, the overdose mortality rate was about the same in both populations. The overdose mortality rate among American Indian or Alaska Native people also rose significantly and by 2019 was 15% higher than the overdose mortality rates of Black and White people.

“Drug overdose mortality is increasingly becoming a racial justice issue in the U.S.,” Friedman and Hansen wrote in the JAMA Psychiatry report. “Providing individuals with a safer supply of drugs, closing gaps in health care access (for example, harm reduction services and medications for opioid use disorder), ending routine incarceration of individuals with substance use disorders, and addressing the social conditions of people who use drugs represent urgently needed, evidence-based strategies that can be used to reduce increasing inequalities in overdose rates.”

For related information, see the Psychiatric News article “Opioid Overdose Death Rate Rose Faster for People of Color” and the American Journal of Psychiatry article “Surging Racial Disparities in the U.S. Overdose Crisis.”

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