CDC reports historic rise in overdose deaths, particularly in underrepresented groups
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A new report from the CDC showed that overdose death rates jumped in 2020, especially for people in underrepresented racial and ethnic groups. CDC officials said the historic increase was largely driven by fentanyl.
Compared with 2019, the number of drug overdose deaths per 100,000 people increased 44% for Black people, 39% for American Indian and Alaska Native people and 24% for white people.
“People from certain racial and ethnic minority groups have higher drug overdose death rates, and less access to treatments for substance use disorders that are known to work,” Mbabazi Kariisa, PhD, MPH, a health scientist for CDC’s division of overdose prevention and coauthor of the report, said during a press briefing. “This difference is not simply because of the lack of availability of services and communities that have a higher capacity to provide care.”
The report, which included drug overdose data from 25 states and Washington D.C., revealed that young Black people aged 15 to 24 years saw the most significant increase at 86%. Black men aged 65 years and older had an overdose death rate about seven times that of white men aged 65 years and older. In addition, among American Indian and Alaska Native women aged 25 to 44 years, overdose death rates were nearly two times that of white women the same age.
“Racism, a root cause of health disparities, continues to be a serious public health threat that directly affects the well-being of millions of Americans and, as a result, affects the health of our entire nation,” Debra Houry, MD, MPH, CDC acting principal deputy director, said during the briefing.
The rapid increase was mostly driven by illicitly manufactured fentanyl and fentanyl analogs, according to the CDC, but the COVID-19 pandemic likely contributed because of disruptions in prevention, treatment, harm reduction and recovery support services.
“The increase in overdose deaths and widening disparities are alarming,” Houry said in a press release.
The report showed a correlation between county-level income inequality and overdose rates. Kariisa said that “areas with a wider income gap between the rich and the poor have higher rates of overdose deaths,” and that “among Black people, overdose rates in counties with the most income inequality are more than twice those of counties that had less income inequality.”
“Income inequalities often negatively impact people from racial and ethnic minority groups at higher levels,” Kariisa said. “This can lead to lack of stable housing, reliable transportation and health insurance, making it even more difficult for people to access treatment and other support services. The results in this report show how important prevention strategies are to reducing the risk for overdose and health related disparities.”
Another particularly troubling area of the report, Kariisa said, is that a history of substance use was commonly reported but treatment was not.
“There was a substantially lower percentage of people from racial and ethnic minority groups showing evidence of ever receiving treatment for substance use,” Kariisa said. “The percentage with evidence of prior treatment for substance use was lowest for Black people at one in 12. Among American Indian and Alaska Native people, and Hispanic people, only about one in 10 received prior substance use treatment. In fact, most people who died by overdose had no evidence of getting substance use treatment before their death.”
In the report, Kariisa and colleagues wrote that “prioritizing prevention and substance use disorder treatment for persons in areas with higher economic inequities is particularly important.”
These overdose deaths are preventable, Houry said, yet they “continue to reap excess harm on the health and well-being of certain groups.” The crisis, according to the CDC, requires tailored efforts to enhance prevention, treatment, recovery and harm reduction.
In order to “end drug overdose death disparities, we will need to address the systemic factors,” Houry said, like “lack of awareness of just how lethal the illicit drug supply is.” Additionally, she said it will be important to “address the limited or, in some cases, lack of access to treatment, recovery services and harm reduction actions known to work.”
“The goal is to prevent health differences from evolving into public health injustice,” she said.
Every person can help prevent overdoses, Houry continued, by raising awareness about the communities disproportionately impacted by overdoses; learning to reduce stigma, which “can be a major barrier for those seeking help;” reading and sharing overdose prevention resources; learning to recognize the signs of an overdose; and “carrying lifesaving naloxone with you.”
“I keep it in my bag, just like I carry a first aid kit to protect family, friends or anyone in the community from an overdose,” Houry said. “While we put these actions to work, we must also attend to the long-standing inequities, and the root drivers of substance abuse and overdose disparities. One of the ways we can address this is through primary prevention efforts by preventing or mitigating the effects of adverse childhood experiences that can increase the risk for substance use.”
Houry further said that the CDC is “committed to addressing the challenges driven by structural factors, racism, discrimination and historical disenfranchisement that deeply impacts the communities we live in.”
“As an agency, you recognize the systemic nature of the inequities that exist across our nation, and our communities where people live, learn, work and play, and in our health care infrastructure,” she said. “We are working to address the many roadblocks that prevent access to care for all. ... We believe that now is the time to provide communities with the additional resources they need.”
References:
- Overdose death rates increased significantly for Black, American Indian/Alaska Native people in 2020. https://www.cdc.gov/media/releases/2022/s0719-overdose-rates-vs.html. Published July 19, 2022. Accessed July 19, 2022.
- Kariisa M, et al. MMWR Morb Mortal Wkly Rep. 2022; doi: 10.15585/mmwr.mm7129e2.
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