Substance Use
A Crisis within a Crisis: Accelerating Racial Disparities in the US Overdose Epidemic Kumi Smith* Kumi Smith Colin Planalp Sarah Bennis Anotny Stately Jack Martin Ivan Nelson Pearl Evans
INTRODUCTION: More Americans died in 2021 from drug overdose than vehicle accidents or firearms combined. Mortality rates are climbing in all social groups, but the impact of recent system shocks—the COVID-19 pandemic, the fentanyl crisis—disproportionately affect racial and ethnic minoritized communities. Such shifts merit closer examination of race-specific mortality trends.
METHODS: We used the Centers for Disease Control and Prevention WONDER (Wide-Ranging Online Data for Epidemiologic Research) database to calculate age-adjusted opioid overdose mortality per 100,000 population by race and ethnicity from 1999 to 2022. We also explored trends in co-use of opioids with cocaine and methamphetamines, as well as state-specific Native/white and Black/white mortality rate differences.
RESULTS: Overdose deaths have increased 174% since 2009 when CDC first declared it an epidemic. Death disparities between Native and white (mortality rate difference [MRD], 28.7 deaths/100,000) and Black and white (MRD, 12.3 deaths/100,000) populations have reach an all-time high, while Asian and Hispanic/Latino rates remain below the national average. Native-white disparities are greatest in Minnesota (MRD, 237.4) and Black-white disparities are greatest in Washington DC (MRD, 106.8). Deaths from co-use are rising most rapidly in Native (opioids and methamphetamines) and Black (opioids and cocaine) Americans.
CONCLUSION: Recent accelerations in mortality across all groups predate the COVID-19 pandemic, implicating long-standing drivers of addiction and overdose. Black and Native overdose deaths in particular have reached crisis levels since the mid-2010’s. Historic exclusion of these groups from access to medically prescribed opioids forced them to rely solely on an illicit drug supply increasingly contaminated with fentanyl. Future strategies to address these disparities must integrate their interrelated determinants including criminal/legal, socioeconomic, and stigma related factors.
