In the United States, drug use and overdose have been increasing year after year, leading to unprecedented numbers of fatalities. Recent reports suggest that the number of overdose deaths has been decreasing across the country in the last year or so. However, when looking closer at these figures, there are clear disparities, with many communities seeing a rise in deaths.
Trends in drug overdose deaths
In 2023, drug overdose deaths decreased nationwide for the first time in several years. The Centers for Disease Control and Prevention (CDC) reports a 3% decrease from 2022 to 2023 and a 10% decrease from April 2023 to April 2024.
Prior to this, overdose deaths were increasing rapidly each year, reaching an all-time high following the COVID-19 pandemic. The vast majority of these deaths were linked to opioids, particularly synthetic opioids such as fentanyl. [2]
This recent decline in overdose deaths is believed to be caused by several factors, including: [3][4]
- Less fentanyl contamination in the drug supply
- People becoming more aware of or tolerant to fentanyl
- Increase in availability of naloxone
- Increase in availability of opioid use disorder treatments, such as buprenorphine
However, these figures do not accurately represent the changes within certain communities. While overdose deaths are declining among white Americans, they continue to rise among Black, Hispanic, and Native communities. In 2021 and 2022, overdose deaths were highest among American Indian and Alaska Native people, with a 15% increase in fatalities between 2021-2022. [5]
Additionally, there are large disparities in the number of overdose deaths when looking at individual states. Some states have seen a significant decrease, such as North Carolina with almost half as many deaths in May 2024 as in May 2023. Other states, such as Nevada and Oregon, have seen an increase in fatalities. [2]
Furthermore, some states, such as Maryland and Massachusetts, which reported a decrease in overdose deaths from 2022 to 2023, saw declines that occurred almost entirely among white people, while deaths among Black people have increased.
What’s behind the racial disparities in overdose deaths?
Racial disparities in overdose deaths can be attributed to or linked to several factors, such as:
- Treatment access: Substance use treatments are often not targeted toward or reaching Black, Native, or Hispanic communities, including disparities in the distribution of naloxone and education around its administration. [7][8]
- Mistrust or doubt in services: Many treatments fail to recognize cultural needs, language barriers, or racial biases, discouraging people from seeking help. [9]
- Fear of stigma or arrest: Black, Native, and Hispanic people face stigma from service providers, impacting the quality of care and willingness to access treatment. Additionally, this can contribute to a fear of attending treatment centers such as methadone clinics due to a fear of being arrested for drug use. [9][10]
- Impact of COVID-19: During the COVID-19 pandemic, some communities were disproportionately affected by the changes in the drug supply, economic impacts, and access to services. [10]
How fentanyl is driving the disparity in overdose deaths
Fentanyl is often found mixed with other drugs, such as heroin, cocaine, and methamphetamine. It is extremely potent, around 100 times more potent than morphine, meaning that small doses can be fatal. From 2020-2021, overdose deaths involving synthetic opioids, particularly fentanyl, increased by 55.6%. [1]
In 2010, opioid overdose deaths were seen more among white people in rural communities. Since then, opioid death rates have increased across the US, with the largest increase among Black people. [10][12] In 2020, opioid death rates among Black communities surpassed the rate among White people. [13]
How COVID-19 worsened the overdose crisis
During the COVID-19 pandemic, overdose death rates surpassed 100,000 for the first time in history, with the majority of deaths being associated with fentanyl and other opioids. [2] Several factors contributed to this increase, including: [8][10][14]
- Drugs being used in isolation, thus increasing the risk of fatal overdose and decreasing the likelihood of help-seeking
- Reduced access to healthcare services due to social distancing and limited resources
- Reduced implementation of harm reduction strategies among communities, such as naloxone
- Changes in drug supply chains and substance availability, contributing to the increase of illicit fentanyl
- Increase in risk factors that contribute to substance use, such as stress, mental health issues, and socioeconomic difficulties
Efforts to address racial disparities in overdose deaths
Various initiatives have been implemented in recent years to try and combat the racial disparities in overdose deaths and reduce the overall number of drug-related fatalities.
For example, in 2018, the National Institute of Health (NIH) formed the HEAL (Helping to End Addiction Long-term) Initiative, which contributes funds and resources to over 1800 projects nationwide. This initiative aims to address the opioid crisis through new research and approaches toward substance use prevention and treatment, pain management, and health equity.
The Native Collective Research Effort to Enhance Wellness (N CREW) Program is one of many projects focused on this objective. N CREW aims to improve substance use disorders and pain management among Native American communities, utilizing Native-led research and perspectives.
The future of drug overdose prevention in minority communities
Factors that have contributed to a decrease in overall overdose deaths across America include increased medications, access to treatment, and education about fentanyl. Addressing racial disparities in overdose deaths involves ensuring that these interventions reach all individuals and communities nationwide. [9]
Resources and interventions must be allocated and tailored to specific needs among communities, recognizing differences in cultures and traditions, socio-economic influences, and the impact of generational trauma and violence. [6][10]
Stigma and discrimination, significantly linked to systemic racism, needs to be addressed. This will improve the quality of care received by minority communities, particularly mental health diagnoses and their link to substance use issues. [8][12]