Racial and Ethnic Disparities in Drug Overdose Deaths in the US During the COVID-19 Pandemic

Han, Beth; Einstein, Emily B.; Jones, Christopher M.; Cotto, Jessica; Compton, Wilson M.; Volkow, Nora D.

doi:10.1001/jamanetworkopen.2022.32314

Cited by 72 publications

(63 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We focused separately on each of these four mutually exclusive major drug categories, because they are involved in a large number of overdoses in the United States, and because of their different pharmacological and pathophysiological effects [3,4,24,99,100]. Analogous examination for other drug categories would also be valuable, for example prescription opioids [6].…”

Section: Limitationsmentioning

confidence: 99%

“…As mentioned in the Introduction, there have been increases in overdose mortality for both synthetic opioids and psychostimulants during the COVID-19 pandemic period [1,4,51]. Furthermore, mortality due to COVID-19 is also greater in men versus women [50,104], and substance use disorders have been detected as a comorbidity with this viral infection [51,56].…”

Section: Limitationsmentioning

confidence: 99%

“…A recent report from the CDC, summarizing data from 2019 and 2020, including the COVID-19 pandemic, for 25 states and the District of Columbia, showed an overall increase in overdose mortality for all drugs combined, with a greater rate in men versus women [25]. Similarly, a United States nation-level analysis of mortality data, stratified as ages 15-34 or 35-64, found that overdoses from synthetic opioids (including fentanyl but not heroin) and psychostimulants (including methamphetamine but not cocaine) increased from March 2018 to March 2021 (i.e., covering the onset of the COVID-pandemic [4]), again with highest mortality was in men with minority status (e.g., African-American) [4]. Prior to the COVID-19 pandemic, a national-level report of CDC data from 2017-2018 showed that men compared to women had greater overdose mortality for all opioids combined, and also for prescription opioids (e.g., oxycodone) [6].…”

Section: Introductionmentioning

confidence: 99%

“…As mentioned above, there has been an increase in overdoses due to synthetic opioids during recent years, especially 2020 and thereafter, coinciding with the COVID-19 pandemic [1,4,48]. COVID-19 mortality, which is greater in men versus women, also involves respiratory distress [49-51], and the presence of specific SUD is also noted as a risk factor for COVID-19 infection [51,52].…”

Section: Introductionmentioning

confidence: 99%

“…Overdose deaths due to the use of opioids [-opioid receptor (MOP-r) agonists such as fentanyl and heroin], or psychostimulants such as methamphetamine and cocaine, have increased considerably in recent years in the United States [1][2][3]. Starting in 2020, and following the onset of the COVID-19 pandemic, there has been a further increase in overdose mortality for some substances (e.g., synthetic opioids such as fentanyl or the psychostimulant methamphetamine), but not others (e.g., heroin and other opiates) [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Overdose mortality rates for opioids or stimulants are higher in males than females, controlling for rates of drug misuse: State-level data

Butelman¹,

Huang²,

Goldstein³

et al. 2023

Preprint

Self Cite

View full text Add to dashboard Cite

Drug overdoses are an escalating cause of mortality in the United States, with potential sex differences across the lifespan. The objective of this study was to use state-level nationally representative data that includes the COVID-19 pandemic period to determine overdose mortality for specific drug categories across the lifespan of men and women. We used Centers for Disease Control and Prevention (CDC) Multiple Cause of Death 2020-2021 data on overdose mortality, for 50 states and District of Columbia, across 10-year age bins (age range: 15-74). The outcome measure was sex-specific crude overdose death rate (per 100,000) for: synthetic opioids excluding methadone (ICD-10 code: T40.4; e.g., fentanyl), heroin (T40.1), psychostimulants with abuse potential (T43.6; e.g., methamphetamine), and cocaine (T40.5). Multiple regression analyses adjusted for ethnic-cultural background and household net worth from Census data, and sex-specific rate of misuse of the relevant substances, from the National Survey on Drug Use and Health (2019-2020). For each of these major drug categories, men had greater overall overdose mortality than women. Although overall rates of mortality differed across jurisdictions, the sex ratio of mortality for each drug category was relatively stable (≈2- to 3-fold greater mortality in men vs women). These findings survived adjustment for state-level ethnic-cultural and economic variables, and for sex-specific misuse of each drug type (especially in the 25-34, 35-44, 45-54 and 55-64 age bins). These findings underscore the need for research into sex- and gender-based mechanisms underlying differential vulnerability in overdose mortality for these drugs, based on their diverse pharmacodynamics and pathophysiology.

show abstract

Section: Limitationsmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Overdose mortality rates for opioids or stimulants are higher in males than females, controlling for rates of drug misuse: State-level data

Butelman¹,

Huang²,

Goldstein³

et al. 2023

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

Racial, Ethnic, and Sex Differences in Methadone-Involved Overdose Deaths Before and After the US Federal Policy Change Expanding Take-home Methadone Doses

et al. 2023

View full text Add to dashboard Cite

ImportanceIn March 2020, the Substance Abuse and Mental Health Services Administration (SAMHSA) permitted states to relax restrictions on take-home methadone doses for treatment-adherent patients to minimize COVID-19 exposures.ObjectiveTo assess whether the methadone take-home policy change was associated with drug overdose deaths among different racial, ethnic, and sex groups.Design, Setting, and ParticipantsInterrupted time series analysis from January 1, 2018, to June 30, 2022. Data analysis was conducted from February 18, 2023, to February 28, 2023. In this population-based cohort study of drug overdose mortality including 14 529 methadone-involved deaths, monthly counts of methadone-involved drug overdose deaths were obtained for 6 demographic groups: Hispanic men and women, non-Hispanic Black men and women, and non-Hispanic White men and women.ExposureOn March 16, 2020, in response to the first wave of the COVID-19 pandemic, SAMHSA issued an exemption to the states that permitted up to 28 days of take-home methadone for stable patients and 14 days for less stable patients.Main Outcome MeasuresMonthly methadone-involved overdose deaths.ResultsFrom January 1, 2018, to June 30, 2022 (54 months), there were 14 529 methadone-involved deaths in the United States; 14 112 (97.1%) occurred in the study’s 6 demographic groups (Black men, 1234; Black women, 754; Hispanic men, 1061; Hispanic women, 520; White men, 5991; and White women, 4552). Among Black men, there was a decrease in monthly methadone deaths associated with the March 2020 policy change (change of slope from the preintervention period, −0.55 [95% CI, −0.95 to −0.15]). Hispanic men also experienced a decrease in monthly methadone deaths associated with the policy change (−0.42 [95% CI, −0.68 to −0.17]). Among Black women, Hispanic women, White men, and White women, the policy change was not associated with a change in monthly methadone deaths (Black women, −0.27 [95% CI, −1.13 to 0.59]; Hispanic women, 0.29 [95% CI, −0.46 to 1.04]; White men, –0.08 [95% CI, −1.05 to 0.88]; and White women, −0.43 [95% CI, −1.26 to 0.40]).Conclusions and RelevanceIn this interrupted time series study of monthly methadone-involved overdose deaths, the take-home policy may have helped reduce deaths for Black and Hispanic men but had no association with deaths of Black or Hispanic women or White men or women.

show abstract

Educational Attainment and US Drug Overdose Deaths

Powell

2023

JAMA Health Forum

View full text Add to dashboard Cite

ImportanceEducational attainment in the US is associated with life expectancy. As the opioid crisis worsens, it is critical to understand how overdose death rate trends evolve across education groups.ObjectiveTo investigate the association between educational attainment and overdose death rates, with emphasis on trends during the COVID-19 pandemic.Design, Setting, and ParticipantsThis cross-sectional study used National Vital Statistics System Mortality Multiple Cause-of-Death data describing overdose death rates in the US by educational attainment from January 1, 2000, to December 31, 2021, with a focus on 2018 to 2021. Overdose deaths were aggregated by year and educational level for decedents aged 25 years or older.ExposureEducational attainment, categorized as no high school (HS) diploma, HS diploma (or General Educational Development) but no college, some college but no bachelor’s degree, and bachelor’s degree or more.Main Outcomes and MeasuresThe main outcomes were rates of all overdose deaths, overdose deaths involving opioids, and overdose deaths involving synthetic opioids.ResultsOf 912 057 overdose deaths with education information from 2000 to 2021 (mean [SD] age at death, 44.9 [12.3] years; 64.1% male), there were 625 400 deaths (68.6%) among individuals with no college education and 286 657 deaths (31.4%) among those with at least some college. The overdose death rate was 19.9 per 100 000 population. From 2018 to 2021, there were 301 557 overdose deaths, including 58 319 (19.3%) among individuals without an HS diploma, 153 603 (50.9%) among people with an HS diploma, 64 682 (21.4%) among individuals with some college, and 24 953 (8.3%) among individuals with a bachelor’s degree. There were 3324 overdose deaths (1.1%) among American Indian or Alaska Native individuals, 2968 (1.0%) among Asian American or Pacific Islander individuals, 49 152 (16.3%) among Black individuals, 31 703 (10.5%) among Hispanic individuals, 211 359 (70.1%) among White individuals, and 3051 (1.0%) among multiracial individuals. From 2018 to 2021, the overdose death rate was 33.4 per 100 000 population, the opioid-related overdose death rate was 24.2 per 100 000 population, and the synthetic opioid overdose death rate was 19.1 per 100 000 population. From 2018 to 2021, the overdose death rate for those without a HS diploma increased by 35.4 per 100 000 population compared with 1.5 per 100 000 population for those with a bachelor’s degree. This differential growth was primarily due to increased rates of death involving synthetic opioids.Conclusions and RelevanceIn this cross-sectional study, lower educational attainment was found to be associated with higher growth in overdose deaths. As the opioid crisis has transitioned to fentanyl and polysubstance use, overdose deaths have become more prevalent in groups with lower socioeconomic status, potentially exacerbating existing life-expectancy disparities.

show abstract

Racial and Ethnic Disparities in Drug Overdose Deaths in the US During the COVID-19 Pandemic

Abstract: This cross-sectional study describes the nationwide trends in drug overdose mortality during the COVID-19 pandemic by age, sex, and race and ethnicity.

Cited by 72 publications

References 7 publications

Overdose mortality rates for opioids or stimulants are higher in males than females, controlling for rates of drug misuse: State-level data

Overdose mortality rates for opioids or stimulants are higher in males than females, controlling for rates of drug misuse: State-level data

Racial, Ethnic, and Sex Differences in Methadone-Involved Overdose Deaths Before and After the US Federal Policy Change Expanding Take-home Methadone Doses

Educational Attainment and US Drug Overdose Deaths

Contact Info

Product

Resources

About