The rate of deadly drug overdoses among Black people in 2020 topped the rate among whites for the first time since 1999, according to a new analysis.
The Black overdose mortality rate increased by nearly 50% – from 24.7 deaths for every 100,000 people in 2019 to 36.8 per 100,000 in 2020, according to the analysis published Wednesday in the journal JAMA Psychiatry. The rate among whites was 31.6 per 100,000 in 2020, representing a gap of about 16%.
“This really marks kind of a stark shift from 2010,” when the fatal overdose rate among whites was double that of Black individuals, says study co-author Joseph Friedman, an addiction researcher and MD/Ph.D. candidate in the UCLA-Caltech Medical Scientist Training Program.
The analysis by Friedman and Dr. Helena Hansen, a UCLA professor and associate director of the school’s Center for Social Medicine and Humanities, notes that it used provisional data from 2020 and may underestimate final mortality rates. Yet its key finding of the Black overdose rate surpassing the rate of whites that year aligns with final data in a Centers for Disease Control and Prevention analysis published in December.
Across the board, according to the new analysis, having increased in overdose mortality rates in 2020 were higher for all racial and ethnic groups studied than in any prior year over the last two decades, with black individuals the largest percentage increase from 2019 at 48.8% . The rate among whites increased by about 26%.
American Indian or Alaskan Native individuals had the highest mortality rate from drug overdoses in 2020, at more than 41 deaths for every 100,000 people to mark a 43% increase year over year. Hispanic or Latino individuals had the lowest overdose mortality rate of any racial and ethnic group studied at approximately 17 per 100,000 in 2020. Yet the overdose mortality rate increased by some 40% among Hispanic and Latino individuals from 2019.
Friedman says the trends within overdose mortality highlight a greater need for stakeholders and policymakers to consider racial equity when developing interventions and making decisions on where to allocate addiction treatment resources and support.
“It’s really important that the opioid crisis was discussed and tackled as an urgent racial justice issue,” Friedman says.
Fueled heavily by prescription opioids early on, the US drug epidemic of recent years was initially seen as a problem primarily impacting whites, though research has found that prescription opioid use was as prevalent among Black people as white people by the mid-2000s. Still, by 2010, the overall drug overdose death rate among whites was 15.8 per 100,000, double the rate of Black individuals at 7.9 per 100,000 for that year, according to the UCLA researchers’ report.
Eventually, restrictions on opioid prescribing implemented to stem overdose deaths fueled a shift in use from prescription medications like the painkiller oxycodone to illicit drugs like heroin and the synthetic opioid fentanyl. Synthetic opioids are the leading cause of opioid-related overdoses in the US, accounting for nearly 73% of such deaths in 2019, according to the CDC. Polysubstance use also has played a role in US drug mortality.
Friedman says a rise in the use of illicit drugs, which can be more potent and less predictable than prescribed opioids, has disproportionately impacted communities of color. According to the study, each year since 2012, Black communities have experienced higher annual percentage increases in rates of overdose death compared with white communities, steadily narrowing the gap in the overall mortality rate.
Though data has shown Black and white individuals use drugs at similar rates, Friedman says inequalities evident in higher rates of drug-related arrests and incarcerations among Black individuals – as well as in access to addiction treatment and medication such as buprenorphine – are factors that have likely contributed to the disparity in overdose deaths.
As more people of color of color by the opioid crisis and as the crisis itself is affected by drugs like fentanyl, Friedman fears the nature of the response also may change from viewing the problem through a health care lens to one that requires a heer hand by law enforcement.
While efforts in recent years to decriminalize the use and possession of marijuana have been successful, lawmakers have set sights on imposing harsher penalties around fentanyl, which Friedman says harks back to the approaches used toward crack cocaine in the 1980s.
“I think a really good solution and path forward would be for addiction and the overdose crisis to be explicitly seen as part of the racial justice movement,” Friedman says. “That’s a necessary step for making progress now that this issue is not seen as a white problem anymore.”