US Overdose Deaths Disproportionately Affect Minority Communities

With overdose deaths from illict drugs continuing to rise in the US, a new study shows that minority communities have been hit especially hard by the epidemic.¹

More than 580 000 Americans have died from stimulant- and opioid-related overdoses in the past 20 years, including 100 000 deaths in 2020 alone. Black men and American Indian/Native Alaskan men and women experienced the highest death rates, according to Abeena Jones, PhD, assistant professor of human development and family studies at Penn State University and the study’s lead author.

“During the COVID-19 pandemic, overdose rates for Black individuals overtook those of whites for the first time,” Jones said in an accompanying press release.² “We wanted to delve into the nuances within those overdose deaths and also look at treatment admissions to gauge how treatment for substance use disorders looks among race, ethnicity and gender.” The study was published in the journal Drug and Alcohol Dependence.

The study’s authors used data from the Substance Abuse and Mental Health Administration to study treatment admissions for substance abuse between 1992 and 2019. They used data from the Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research to analyze overdose deaths from 1999 to 2020.

In addition, they grouped the data into 6 substance categories—cocaine, opioid, methamphetamines, cocaine and opioid, cocaine and methamphetamines, and opioid and methamphetamines—so as to examine treatment and overdose rates by race and gender.

They found that while all racial groups and genders saw increases in overdose deaths and treatment admissions, the crisis has been especially acute for members of minority communities in both urban and rural areas. Black men experienced the highest rate of cocaine-related overdose deaths of any group. American Indian/Native Alaskan communities experienced the highest rates of methamphetamine treatment admissions and deaths.

Black men experienced the highest rate of cocaine-related overdose deaths of any group. American Indian/Native Alaskan communities experienced the highest rates of methamphetamine treatment admissions and deaths.

“We know there are different patterns of overdoses and treatment by race, ethnicity and gender, and certainly for different substances,” said Joel Segel, PhD, associate professor of health policy and administration at Penn State. “Bringing all these data together helps us see patterns — including where overdose cases and treatment are not matching — indicating there might be a lack of treatment that needs to be addressed.”

They also found that polysubstance abuse—the combination of opioids and stimulants—is behind the current wave of drug overdoses. “Fentanyl is strong and relatively cheap, so you see other substances get adulterated with it,” Segel said. “I think part of what's currently going on is there are cases where someone thinks they're using methamphetamines or cocaine but does not necessarily know that the substance contains fentanyl.”

Jones said the crisis has hit hardest in high-distressed neighborhoods or rural and urban places with low income, a lack of housing, underserved schools, and other factors that would put someone at a disadvantage simply by living there. Racial and ethnic minorities are more likely to live in areas like these than White individuals, and substance use may become a coping mechanism to alleviate the stress of adverse conditions. These areas also may lack access to naloxone, the life-saving opioid overdose reversal drug, she added.

The study’s authors said their findings show a need for substance use interventions that take race, ethnicity, and gender into consideration. Examples mentioned include culturally sensitive components in treatment content; having providers and treatment support staff of the same racial/ethnic and gender identities as the population served; having providers and treatment staff with lived experience in addiction recovery, and accounting for logistical barriers that inhibit treatment access and completion, such as transportation and child care. They also noted that increased access to lifesaving medications like naloxone, and using harm reduction strategies like fentanyl test strips can help to reduce overdose deaths.

“Our society is on the pay later plan, which is much more costly in terms of criminal justice costs and the costs of social disruptions,” Jones said. “It’s in our best interest to intervene sooner than to pay more later.”

References

1. Jones AA, Shearer RD, Segel J, et al. Opioid and stimulant attributed treatment admissions and fatal overdoses: Using national surveillance data to examine the intersection of race, sex, and polysubstance use, 1992-2020. Drug Alcohol Depend. 2023;249:109946. doi: 10.1016/j.drugalcdep.2023.109946.

2.