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More opioid prescriptions, overdoses among whites than other ethnicities

Whites were more likely to receive prescriptions for opioids and were more likely to die of an overdose, according to two new studies published in JAMA Internal Medicine. A third study indicated that overall opioid prescribing was decreasing in the majority of counties in the United States.

These findings that the opioid crisis is affecting whites at a higher rate is a stark contrast to previous drug-related health concerns, according to researchers.

“Most drug epidemics in the United States have disproportionately affected nonwhite communities,” Joseph Friedman, MPH, from the David Geffen School of Medicine at the University of California, Los Angeles. “Notably, the current opioid epidemic is heavily concentrated among low-income white communities, and the roots of this racial/ethnic phenomenon have not been adequately explained.”

The three studies assessed the racial/ethnic and income differences in prescriptions for opioids and other controlled medications in California, racial disparities in opioid overdose deaths in New York City and opioid prescribing rates by county in the United States.

In the study by Friedman and colleagues, the researchers observed an almost 300% difference in the prevalence of opioid prescriptions across the race/ethnicity-income gradient in California. In the quintile of zip code tabulation areas with the lowest-income/highest proportion-white population, 44.2% received at least one opioid prescription each year. In the quintile with the highest-income/lowest proportion-white population, 16.1% received at least one opioid prescription. Among all individuals aged 15 years or older, 23.6% received at least one opioid prescription.

In mostly white high-income areas, there was a high concentration of stimulant prescriptions, according to Friedman and colleagues. Specifically, the prevalence was 3.8% in the quintile with the highest-income/highest proportion-white population and 0.6% in the quintile with the lowest-income/lowest proportion-white population.

There was no income gradient for benzodiazepine prescriptions; however, they were concentrated in mostly white areas, according to Friedman and colleagues. Each year, at least one prescription for a benzodiazepine was received by 15.7% of adults in the quintile of zip code tabulation areas with the highest proportion-white population vs. 7% in the quintile with the lowest proportion-white population.

In a second study by Bennett Allen, MA, from the Bureau of Alcohol and Drug Use Prevention, Care, and Treatment at the New York City Department of Health and Mental Hygiene, and colleagues, the researchers identified 1,487 overdose deaths in New York City. Of these deaths, 37% were among whites, 28% were among blacks, 31% were among Latinos and 4% were among other or undefined racial/ethnic groups.

The death rates per 100,000 New Yorkers due to heroin and/or fentanyl overdoses among younger people aged 15 to 34 years were higher among whites (22.2; 95% CI, 19-25.5) than blacks (5.8; 95% CI, 4-8.2) or Latinos (9.7; 95% CI, 7.6-12.1), according to Bennet and colleagues. In contrast, among older people aged 55 to 84 years, the rates of heroin and/or fentanyl overdose death were higher among blacks (25.4; 95% CI, 20.9-30) than whites (9.4; 95% CI, 7.3-11.8).

Overall, the death rates from cocaine overdoses were significantly higher among older blacks (25.4; 95% CI, 20.9-30) than whites (5.1; 95% CI, 3.6-7) and Latinos (11.8; 95% CI, 8.9-15.4), according to Bennett and colleagues.

In a third study by Gery P. Guy Jr, PhD, MPH, from the National Center for Injury Prevention and Control at the CDC, and colleagues, data indicated that there was a decrease in the amount of opioid prescriptions in the United States by 20.1% from 2015 to 2017. Additionally, there was a decrease in opioid prescribing rates by 16.9% and high-dose prescribing rates by 25.3%. There was also a 6% decrease in the average daily morphine milligram equivalent per prescription. However, there was a 3.4% (17.7 to 18.3 days) and 33.3% (15 to 20 days) increase in the average and median duration of opioid prescriptions, respectively.

At the county level, there was a substantial variation in the amount of opioids prescribed per capita in 2017, according to Guy and colleagues. In the highest quartile, the average amount of opioids prescribed was 1,061 morphine milligram equivalent per capita — nearly six times the amount in the lowest quartile (182.8 morphine milligram equivalent per capita).

The highest and lowest prescribing counties demonstrated significant variation in overall prescribing rates (4.6 times higher) and high-dose prescribing rates (7.1 times higher), according to Guy and colleagues.

Most counties had a decrease in the amount of opioids prescribed (74.7%), overall prescribing rates (76.3%), and high-dose prescribing rates (76.6%) from 2015 to 2017, according to Guy and colleagues.

“Although the opioid epidemic receives considerable attention in the medical and public health communities, the mainstream media, and even in the national political arena, race/ethnicity is seldom included in discussions about the epidemic,” Friedman and colleagues wrote.

“Race/ethnicity and income are key factors by which variations in prescription prevalence may be understood,” they added. – by Alaina Tedesco

References:

Allen B, et al. JAMA Intern Med. 2019;doi:10.1001/jamainternmed.2018.7700.

Friedman J, et al. JAMA Intern Med. 2019;doi:10.1001/jamainternmed.2018.6721.

Guy Jr., GP, et al. JAMA Intern Med. 2019;doi:10.1001/jamainternmed.2018.6989.

Disclosures: The authors report no relevant financial disclosures.