Fentanyl overdose deaths high among American Indian, Alaska Native, Black individuals
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Key takeaways:
- In 2022, fentanyl-involved overdose mortality rates were highest among American Indian or Alaska Native individuals.
- Black individuals had the largest increase in fentanyl overdose deaths from 2010 to 2022.
Fentanyl-involved overdose mortality rates were disproportionately high among American Indian or Alaska Native and Black individuals compared with other racial and ethnic groups, according to a research letter published in JAMA Psychiatry.
“This study highlights the emergence of distinct polysubstance epidemics that disproportionately impact racial and ethnic minorities, with high fentanyl-methamphetamine overdose death rates among non-Hispanic American Indian and Alaska Native populations and high fentanyl-cocaine overdose death rates among non-Hispanic Black populations,” David T. Zhu, BSc, an MD/PhD candidate at Virginia Commonwealth University School of Medicine, told Healio.
Zhu used data from the WONDER Multiple Cause of Death database to calculate crude mortality rates overall and by race and ethnicity (Hispanic and non-Hispanic American Indian or Alaska Native, Asian and Native Hawaiian or Pacific Islander, Black and white) per 100,000 individuals for fentanyl-involved overdoses between 2010 and 2022, stratifying the findings by sex and co-involved drugs.
Results showed that, in 2022, there were 73,838 fentanyl-involved overdose deaths in the U.S. (mean age, 42 years; 73.1% male), with an overall crude mortality rate of 22.15 (95% CI, 21.99-22.31) per 100,000 individuals.
American Indian or Alaska Native individuals had the highest rate of fentanyl-involved overdose deaths that year (42.59 per 100,000 individuals; 95% CI, 39.99-45.19), followed by Black individuals, who also had the largest relative increase in overall fentanyl-involved overdose mortality rates from 2010 to 2022 (0.36 per 100,000; 95% CI, 0.3-0.42 vs. 35.93 per 100,000; 95% CI, 35.35-36.5).
Zhu also observed a higher rate of fentanyl-involved overdose deaths among men (32.65 per 100,000; 95% CI, 32.37-32.92) compared with women (11.83 per 100,000; 95% CI, 11.67-12).
As for fentanyl-involved polysubstance overdose deaths, he found that fentanyl-cocaine deaths were highest among Black individuals (17.02 per 100,000; 95% CI, 16.62-17.41), whereas fentanyl-methamphetamine deaths were highest among American Indian or Alaska Native individuals (17.89 per 100,000; 95% CI, 16.2-19.57).
“To confront the challenges of fentanyl mixed with a dizzying array of synthetic substances and stimulants, we need expanded drug testing, precise epidemiological surveillance and trauma-informed addiction treatment,” Zhu told Healio. “Equally important is removing structural barriers to care so that when FDA-approved therapies for stimulant use disorders become available, they are equitably distributed and accessible to racial and ethnic minorities without the same obstacles that currently limit access to treatments like methadone and buprenorphine.”
Zhu also emphasized the role that clinicians play in reducing racial and ethnic disparities in overdose deaths.
“Frontline clinicians can play a crucial role in addressing the polysubstance overdose epidemic by educating patients about the risks of fentanyl-contaminated drug supplies, often concealed in counterfeit pills or undetectable mixtures,” he said. “Clinicians can also connect their patients with harm reduction resources — such as supervised injection sites, needle exchanges and naloxone — as well as essential social services to address factors like housing instability and financial hardship that increase vulnerability to substance use.”
Zhu acknowledged several study limitations, including its reliance on ICD-10 codes and the potential for racial and ethnic misclassification in death certificates.
“I plan to continue exploring epidemiological trends in the rapidly shifting landscape of the polysubstance overdose epidemic, including the rise of sedatives like xylazine that are not approved for human use,” he said. “Additionally, I am conducting research to examine how harm reduction services can address the socioeconomic, geographical, and racial and ethnic disparities driving overdose deaths.”
For more information:
David T. Zhu, BSc, can be reached at davetzhu@gmail.com.