Opioid-related overdose mortality in the era of fentanyl: Monitoring a shifting epidemic by person, place, and time

• Published in: Drug and alcohol dependence Vol. 216; p. 108321
• Main Authors: Althoff, Keri N., Leifheit, Kathryn M., Park, Ju Nyeong, Chandran, Aruna, Sherman, Susan G.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01-11-2020; Elsevier Science Ltd
• Subjects: Adult; African Americans; Age; Aged; Analgesics, Opioid - poisoning; Centers for Disease Control and Prevention, U.S. - trends; Databases, Factual - trends; Disease control; Drug abuse; Drug overdose; Epidemics; Epidemics - prevention & control; Fatalities; Female; Fentanyl; Fentanyl - poisoning; Health inequity; Heroin; Heroin - poisoning; Humans; Male; Middle Aged; Mortality; Mortality rates; Narcotics; Opiate Overdose - diagnosis; Opiate Overdose - mortality; Opioids; Overdose; Race; Residence; Time Factors; United States - epidemiology; Urban; Urban areas; Young Adult; United States; United States > US; Fentanyl; Urban; Black Americans; Overdose; Health inequity
• ISSN: 0376-8716; 1879-0046
• DOI: 10.1016/j.drugalcdep.2020.108321

•In 2013, there was an increase in the availability of illicitly-manufactured fentanyl in the US.•Non-Hispanic Black (vs. white) Americans had a greater increase in overdose rate.•Urban non-Hispanic Black Americans had the greatest increases in overdose rate.•Older urban non-Hispanic Black men had the greatest increase in fentanyl-induced overdose.•Urban non-Hispanic Black Americans need of harm reduction and drug treatment services.
With the emergence of illicit fentanyl, fentanyl-involved overdose rates increased from 2013 to 2017 in the United States (US). We describe US trends in opioid-related overdose mortality rates by race, age, urbanicity, and opioid type before and after the emergence of fentanyl.
Using the Centers for Disease Control and Prevention’s WONDER database, we estimated crude and age-standardized opioid-related overdose mortality rates at the intersections of race (non-Hispanic [NH] Black and white), age (<55 and ≥55 years), sex (male and female) and urbanicity (urban and rural residence) from 2005 to 2017. We compare relative changes in mortality from 2013 to 17, and describe changes in the contributions of fentanyl, heroin, and other opioids to opioid-related overdose mortality.
From 2013 to 2017, the overall opioid overdose mortality rate was consistently higher in NH white Americans, however, the rate increase was greater among NH Black (174 %) compared to NH white (85 %) Americans. The steepest increases occurred in the overdose rates between 2013 and 2017 among younger (aged <55 years) urban NH Black Americans (178 % increase). Among older (≥55 years) adults, only urban NH Black Americans had an increase in overdose-related mortality rate (87 % increase). Urban NH Black Americans also experienced the greatest increase in the percent of fentanyl-involved deaths (65 % in younger, 61 % in older).
In the era of increased availability of illicitly manufactured fentanyl (2013–2017), there has been a disproportionate increase in opioid-related overdose deaths among urban NH Black Americans. Interventions for urban NH Black Americans are urgently needed to halt the increase in overdose deaths.