Drug overdose deaths in 2020 highlight racial disparities

Key takeaways:

• Overdose deaths due to psychostimulants and natural, semi-synthetic and synthetic opioids rose more than expected in 2020.
• Black people had more fentanyl and psychostimulant deaths compared with white people.

There were more drug overdose deaths in 2020 than anticipated based on trends from 2013 to 2019, with more fatalities among Black people compared with white people, according to findings published in PLOS Global Public Health.

“The third wave of drug overdose deaths began in 2013 with the arrival of fentanyl on the illicit drug market,” Maria R. D’Orsogna, PhD, an associate adjunct professor in the department of computational medicine at UCLA, said in a press release. “Although overdose deaths have steadily increased since then, the pandemic year 2020 saw a significant rise of fatalities in many states.”

D’Orsogna and colleagues reviewed overdose death data from the CDC WONDER database, which includes information on number of deaths, cause of death and demographics. The researchers specifically examined drug poisoning mortality rates among four subclasses of drugs: natural and semi-synthetic opioids such as morphine (termed prescription opioids), synthetic opioids other than methadone (termed fentanyl), psychostimulants with abuse potential (termed methamphetamines) and heroin.

From 2013 to 2019, national overdose death rates caused by fentanyl and methamphetamines increased steadily for both men and women. However, in 2020, fentanyl death rates among men were 30% higher than expected and 28% higher than expected among women. For methamphetamines, the death rates exceeded the expected rates by 19% and 18%, respectively.

Analyses by race revealed that fentanyl overdose death rates among Black men in 2018 and women first surpassed the rate of fentanyl overdose death among their white counterparts in 2019. In 2020, the rate was 38% greater among Black men compared with white men, and the rate was 19% greater among Black women compared with white women.

Methamphetamine deaths were consistently greater among white people compared with Black people from 2013 to 2020.

For prescription opioids and heroin, overdose death rates increased from 2013 to 2016 and began decreasing in 2017. In 2020, prescription opioid death rates increased significantly, while heroin overdose death rates continued to decrease.

Analyses by census region and jurisdiction revealed further racial disparities in overdose mortalities.

“Perhaps most surprising to us were the results for the District of Columbia,” Lucas Böttcher, PhD, an assistant professor of computational social science at the Frankfurt School of Finance & Management in Frankfurt am Main, Germany, said in the release. “Here, the 2020 fentanyl-induced mortality was 134 deaths per 100,000 Black male residents but only 14 deaths per 100,000 white male residents. These disparities existed even prior to the pandemic, and are seen in other states as well, such as Illinois or Missouri.”

The findings suggest that pandemic-related anxieties and isolation may have contributed to the increased overdose mortality rates, the researchers said. Moving forward, they emphasized the importance of tailoring prevention programs to at-risk populations such as Black men.

References:

• D’Orsogna MR, et al. PLOS Glob Public Health. 2023;doi:10.1371/journal.pgph.0000769.
• Racial disparities in US drug overdose fatalities significantly higher in 2020. https://www.eurekalert.org/news-releases/983407. Published March 22, 2023. Accessed March 24, 2023.