Racial Health Disparities in Fentanyl Overdoses Worsened in 2020

The racial gap in overdose deaths is not a new phenomenon, but according to new research out of the UCLA David Geffen School of Medicine, those racial health disparities got even worse starting in 2018 and extending into 2020.

Given the heterogeneity of drug overdose deaths during that period, the researchers recommended tailored public health interventions.

The US has been under assault by the opioid crisis for some time, but these latest figures paint a far grimmer picture than statistics could have indicated, the researchers said.

The team looked at drug overdose death data from the National Vital Statistics System from between 2013 and 2020, looking at four drug categories: psychostimulants, like methamphetamines; heroin; natural and semi-synthetic opioids, like prescription painkillers; and synthetic opioids, like fentanyl.

Nationwide and across demographics, overdose deaths from any of those drugs increased during the study period, with the researchers highlighting a significant jump in 2020 past what historical trends could have predicted.

“The third wave of drug overdose deaths began in 2013 with the arrival of fentanyl on the illicit drug market,” Maria R. D’Orsagna, PhD, one of the study’s authors, stated publicly. “Although overdose deaths have steadily increased since then, the pandemic year 2020 saw a significant rise of fatalities in many states.”

Overdose death increases in 2020 were particularly prominent when looking at psychostimulants, which saw a 19 percent increase in overdose deaths among males and 18 percent among females, and fentanyl. Fentanyl overdose deaths increased by 30 percent among males and 29 percent among females.

The researchers indicated that 2020’s notable increase in drug overdose deaths could be the result of pandemic-era uncertainty, plus the ability to order inexpensive illicit drugs to be delivered via the mail.

Notably, these surges are not the same across demographics. Black people, in particular, saw higher rates of fentanyl overdoses during 2020 than other racial groups. The fentanyl overdose death rate for Black men was 38 percent higher than for White men in 2020. Meanwhile, fentanyl overdose death rates were 19 percent higher for Black women compared to White women.

There was some regionality to this, too, the researchers explained.

“Perhaps most surprising to us were the results for the District of Columbia,” Lucas Böttcher, PhD, of the Frankfurt School of Finance and Management, another study author, said in the press 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.”

All said, the fentanyl overdose death rate was 10 times higher for Black men in the District of Columbia (the highest death rate among any racial or regional cohort in the study) than for White men in the same area.

These racial health disparities are important, the researchers said, and warrant further examination. Certain areas, like DC, have stark disparities, while other parts of the country see more equitable outcomes across races. Taking a look at key social determinants of health like poverty, unemployment, and access to prevention and treatment may help experts better understand these differences.

This current study will be helpful for shaping prevention and policy, the researchers argued. Interventions should center on education, they said, including outlining the risks of fentanyl and the potential for less potent drugs to be laced with fentanyl. Public policies about prevention, treatment, and naloxone will also be essential.

Importantly, these interventions need to be tailored to different demographics, given the racial health disparities apparent in this assessment, said Tom Chou, PhD, of UCLA.

“To effectively combat the drug epidemic, given the large heterogeneity of fatality rates, it is essential that we conduct more local-level studies and better understand the unique needs of specific groups, as well as the ways in which culture, socio-economic factors, and geographic conditions influence substance use,” Chou said in a press release.