Racial disparities seen in U.S. drug overdose deaths in first year of pandemic

Increases in U.S. drug overdose deaths from 2019 to 2020 disproportionately affected some demographic groups, according to CDC data.

Researchers used data from the State Unintentional Drug Overdose Reporting System (SUDORS) to analyze overdose death rates from 2019 to 2020 in 25 U.S. states and the District of Columbia by race and ethnicity and county-level social determinants of health, such as income inequality and clinician availability. Rates were reported as overdose deaths per 100,000 population, and differences in age-adjusted death rates were considered statistically significant if the CIs did not overlap. The results were published as a Vital Signs report by Morbidity and Mortality Weekly Report on July 19.

From 2019 to 2020, drug overdose death rates increased by 44% among non-Hispanic Black persons and by 39% among non-Hispanic American Indian or Alaska Native persons versus 22% in White persons. When results were stratified by sex and age group, overdose death rates were higher among older Black men and highest in 2020 among Black men ages 45 to 64 years (124.9 per 100,000 population). Rates among Black men ages 65 years and older were nearly six times as high as those among White men of the same age in 2019 (35.7 versus 6.2 per 100,000 population) and increased to nearly seven times as high in 2020 (52.6 versus 7.7 per 100,000 population).

A history of substance use was common, with highest rates in White, American Indian or Alaska Native, and Hispanic persons (78.3%, 77.4%, and 74.8%, respectively). However, few persons had evidence of previous substance use treatment, with the lowest proportions among Black (8.3%), Hispanic (10.2%), and American Indian or Alaska Native (10.7%) decedents. Larger disparities in overdose deaths, particularly among Black persons, were seen in counties with greater income inequality. Opioid overdose rates in 2020 among Black persons and American Indian or Alaska Native persons were higher in counties with at least one opioid treatment program than in counties without opioid treatment programs (34.3 vs. 16.6 per 100,000 population and 33.4 vs. 16.2 per 100,000 population, respectively), which the authors noted was probably due to long-standing inequities in access to mental health and substance use care.

The authors noted that their study used data from only 26 jurisdictions and that multiracial groups were not included in analyses because of low counts, among other limitations. They concluded that the COVID-19 pandemic has highlighted disparities in access to and provision of care among American Indian, Alaska Native, Black, and Hispanic persons and that their results underscore the increasing impact of the escalating overdose crisis on these populations.

“Provisional estimates indicate continued increases in drug overdose deaths in 2021. Health disparities and inequities are likely exacerbating these increases, particularly among racial/ethnic minority groups,” the authors wrote. “Drug overdoses are preventable, and rapidly scaling up multisectoral, culturally responsive prevention efforts across federal, state, local, and tribal entities that place equity as a central tenet to address the escalating overdose crisis is urgently needed.”

In other research on substance use disorders, a study published in JAMA Network Open on July 15 identified household opioid exposure as a risk factor for opioid misuse and chronic use. Researchers used data from a U.S. commercial insurance provider from Jan. 1, 2008, to Dec. 31, 2016, to quantify the association between postsurgical initiation of prescription opioid use in opioid-naive patients and subsequent prescription opioid misuse and chronic opioid use among opioid-naive family members. Among 843,531 pairs of patients and family members, the latter had 3,894 opioid misuse events (0.5%) and 7,485 chronic opioid use events (0.9%). In adjusted models, each additional opioid prescription refill for the patient was associated with a 19.2% (95% CI, 14.5% to 24.0%) increase in the hazard for opioid misuse in family members, and family members in households with any refill had a 32.9% (95% CI, 22.7% to 43.8%) increased adjusted hazard of opioid misuse. “Opioid refills after surgery were associated with an increased risk of opioid misuse and chronic opioid use among family members,” the authors concluded. “It is important for prescribers, patients, and the public to understand that opioid misuse is a multifaceted problem that extends beyond the patient and has broader implications for the entire family.”