Unintentional Overdose Deaths on the Rise in the U.S.

.ATLANTA — Overdose deaths continued increasing in 2019-2020, especially among Black and American Indian/Alaskan Native (AI/AN) individuals, the CDC reported Tuesday.

Overdose deaths in the U.S. increased by about 30% during that period, said Mbabazi Kariisa, PhD, MPH, a health scientist in the CDC’s Division of Overdose Prevention, during a phone briefing with reporters. “We know that health disparities play a key role in overdose death rates among people in certain racial and ethnic minority groups. In just 1 year, overdose death rates increased 44% for Black people and 39% for American Indian and Alaskan Native people.”

“Overdose death rates also vary by racial and ethnic age groups,” she continued. “Younger Black people — 15 to 24 years old — had the largest increase in overdose death rates: 86% between 2019 and 2020.” Among AI/ANs, “the largest increase of 49% occurred among young people 25 to 44 years old. Also notable, overdose death rates in Black men over 65 were nearly seven times as high as those in older white men.”

The disproportionate increase in overdose death rates among Black and AI/AN people may be partly due to health inequities such as unequal access to substance use treatment, and treatment biases, said Debra Houry, MD, MPH, the CDC’s acting principal deputy director. “Racism, a root cause of health disparities, continues to be a serious public health threat that directly affects the well-being of millions of Americans … When policies, programs, and systems that support health are equitable, poor outcomes can be reduced, deaths can be prevented, and all of society benefits.”

The analysis, which appeared in CDC’s Morbidity and Mortality Weekly Report, looked at overdose deaths in 25 states and the District of Columbia, using data from the State Unintentional Drug Overdose Reporting System (SUDORS). Although the agency funds 47 states to participate in the SUDORS analysis, the report was restricted to the 25 states that had submitted complete data during the reporting period, Kariisa said. Rates were examined by race and ethnicity and county-level social determinants of health (e.g., income inequality and treatment provider availability).

One finding of note was that opioid overdose rates in 2020 were higher in areas with more opioid treatment program availability compared with areas with lower opioid treatment program availability, particularly among Black individuals (34.3 per 100,000 versus 16.6 per 100,000) and AI/ANs (33.4 per 100,000 versus 16.2 per 100,000). “Just because there’s availability of services doesn’t mean that those services are actually accessible,” Kariisa said during the briefing.

She listed lack of insurance as one possible reason why certain minority groups might be less able to access treatment in those geographic areas. In addition, “some of these treatment centers … are not necessarily evenly distributed throughout the areas they live in,” she noted. “So transportation barriers are a factor in limiting people getting access to some of these treatment services. We also know other factors like education, as well as mistrust in the general healthcare system,” may be reasons.

Other findings from the study included:

• Most decedents had a documented history of substance use; white subjects had the most prior use, at 78.3%, followed closely by AI/ANs (77.4%) and Hispanics (74.8%)
• Previous substance use treatment, on the other hand, was low, with Black decedents having the lowest percentage at 8.3%, followed by Hispanic (10.2%) and AI/AN (10.7%) decedents; evidence of naloxone administration was highest among AI/AN (21.5%) decedents and lowest among Asian/Pacific Islander (16.4%) decedents, but was low in all groups
• Among Black persons, the overdose rate for counties with the highest income inequality (46.5 per 100,000) was more than twice that of counties with the lowest income inequality (19.3 per 100,000)

To end these disparities, “we will need to address the systemic factors, such as lack of awareness of just how lethal the illicit drug supply is, and to address the limited — or in some cases, lack of — access to treatments, recovery services, and harm reduction action known to work,” said Kariisa. “The goal is to prevent health differences from evolving into public health injustice.”

Houry mentioned telehealth as an example of an unevenly distributed treatment option. “Sometimes there is structural racism or discrimination where patients could technically be eligible for telehealth, but a provider might not think about using it with that patient … Even if a patient is eligible for telehealth, it might not work for them because they might not have a smartphone, or they might not have a private place to do those calls.”

During a question-and-answer session, Houry was asked whether safe injection sites — such as the one recently opened in New York City — were an example of an effective harm reduction strategy. She responded that although such sites have been open for awhile in other countries, “we haven’t seen [data] in the U.S., so at this point, we don’t have an opinion on it … Once there are good evaluation studies from the site in New York City, we’ll be better poised to give more guidance on this.”

“Everyone can play a role in preventing overdoses,” Houry emphasized, urging people to learn the signs of overdose and to carry naloxone with them. “I keep it in my bag, just like I carry a first aid kit to protect family, friends, or anyone in the community.”

The new nationwide 988 suicide prevention hotline “will be a very helpful tool for those that have mental health issues, or need to talk to somebody to get that referral — certainly people that use substances may have mental health distress or suicidality. This will allow them the opportunity to get that voice on the other side of the line, to get those resources to prevent suicide,” she noted.

If you or anyone you know is struggling with a mental health concern or having thoughts of suicide, please call the Suicide & Crisis Lifeline by dialing 988.