Growing racial/ethnic disparities in overdose mortality before and during the COVID-19 pandemic in California

Abstract

As overdose mortality is spiking during the COVID-19 pandemic, few race/ethnicity-stratified trends are available. This is of particular concern as overdose mortality was increasing most rapidly in Black and Latinx communities prior to the pandemic. We used quarterly, age-standardized overdose mortality rates from California to assess trends by race/ethnicity and drug involved over time. Rates from 2020 Q2-Q4 were compared to expected trends based on ARIMA forecasting models fit using data from 2006 to 2020 Q1. In 2020 Q2-Q4 overdose death rates rose by 49.8% from 2019, exceeding an expected increase of 11.5% (95%CI: 0.5%–22.5%). Rates significantly exceeded forecasted trends for all racial/ethnic groups. Black/African American individuals saw an increase of 52.4% from 2019, compared to 42.6% among their White counterparts. The absolute Black-White overdose mortality gap rose from 0.7 higher per 100,000 for Black individuals in 2018 to 4.8 in 2019, and further increased to 9.9 during the pandemic. Black overdose mortality in California was therefore 34.3% higher than that of White individuals in 2020 Q2-Q4. This reflects growing methamphetamine-, cocaine-, and fentanyl-involved deaths among Black communities. Growing racial disparities in overdose must be understood in the context of the unequal social and economic fallout from the COVID-19 pandemic, during which time Black communities have been subjected to the dual burden of disproportionate COVID-19 deaths and rising overdose mortality. Increased investments are required to ameliorate racial/ethnic disparities in substance use treatment, harm reduction, and the structural drivers of overdose, as part of the COVID-19 response and post-pandemic recovery efforts.

Sociodemographic and geographic disparities in excess fatal drug overdoses during the COVID-19 pandemic in California: A population-based study

“…Consistent with past trends 28 and recent careful analyses of death rates, 3 the non-Hispanic Black population experienced the greatest excess mortality burden due to drug-related overdose, further exacerbating the mortality burden due to COVID-19. 29 Structurally and socially disadvantaged populations often experience disproportionate worsening of their population health profiles in the setting of environmental and/or social crises.…”

“…Consistent with other studies, the largest increase in drug-related overdose deaths occurred due to synthetic opioids, which have become more available in the Western US in recent years. 3 , 24 We found no excess deaths that were due to heroin, further evidence of a crisis that has shifted from overdoses due to opioid prescriptions and heroin to overdoses due to synthetic opioids and poly-drug use. 25 In California, reporting an overdose death due to multiple drugs is not systematized (i.e., death certificates may not list all the drugs involved, and when involved drugs are listed, the reporting is inconsistent) making public health surveillance difficult and slow to calculate the true mortality burden of evolving drug trends (i.e., fentanyl-laced products).…”

“…1 There is substantial variation in opioid-related mortality across geographic region and type of opioid, with recent increases in synthetic opioid deaths and cooccurrence of opioids with other illicit substances 2 in the total population and recent increases in opioid-related mortality in the non-Hispanic Black and non-Hispanic American Indian or Alaska Native populations. 3 , 4 , 5 , 6 , 7 , 8 …”

Associations between classic psychedelics and opioid use disorder in a nationally-representative U.S. adult sample

“…Opioids, including heroin, fentanyl, and prescription opioid compounds, are responsible for approximately 70% of all overdose deaths in the United States 3 . Additionally, over the course of the COVID-19 pandemic, mortality related to opioid overdoses has reached alarming new highs 4 , with the largest increases among members of racial and ethnic minority groups, as well as in areas of socioeconomic disadvantage 5 . Two gold-standard pharmacological treatments exist for opioid dependence—methadone and buprenorphine, both of which are synthetic opiate derivatives.…”

Notes from the Field: Increase in Drug Overdose Deaths Among Hispanic or Latino Persons — Nevada, 2019–2020

“…Reports have documented national and state-level increases in drug overdose–related emergency department visits, emergency medical services incidents, and deaths among racial and ethnic minority groups in the United States during 2020 amid the COVID-19 pandemic ( 1 – 3 ). In June 2021, the Nevada Department of Health and Human Services reported an increase in drug overdose deaths during 2020 among Hispanic or Latino (Hispanic) persons, who make up approximately one third of Nevada’s population ( 4 ).…”