In the first year of the COVID pandemic, drug overdose deaths in the US have risen significantly, with rates higher than recent trends could have predicted. Research published in the open access journal PLOS Global Public Health reports trends in drug overdose deaths between 2013-2020 in four major drug categories by gender, race and geography. It finds a high degree of heterogeneity in overdose patterns between different demographic groups and that the gap in overdose deaths between black and white individuals is widening. Drug prevention and reduction campaigns should therefore be tailored to specific risk groups.

The number of drug overdose deaths has increased in the US over the past two decades. Since 2013, a ‘third wave’ of overdose deaths has emerged, with a shift from prescription opioids to synthetic, particularly illicit fentanyl. Researchers from UCLA, California State University at Northridge, and the Frankfurt School of Finance and Management used the National Vital Statistics System multiple causes of death mortality files, extracting numbers by race and gender in all 50 states plus the District of Columbia. Profs. Maria R. D’Orsogna, Lucas Böttcher and Tom Chou examined the impact of four main categories of drug psychostimulants with addictive potential, such as methamphetamines; heroin; prescription opioids and synthetic opioids such as fentanyl and its derivatives.

They found a significant increase in overdose deaths in all categories except heroin in 2020, with data beating predictions from the 2013-2019 trends. As of 2018, rates among black individuals of both sexes were higher than white individuals for fentanyl and psychostimulants; the gap continued to widen in subsequent years. The highest death rate in 2020 is for black men in the District of Columbia from fentanyl, with the rate nearly 10 times higher than that for white men.

The authors believe that pandemic-related fears and greater availability of cheaper drugs that can be easily ordered online have contributed to the increase in fatal overdoses. They argue that drug prevention strategies should include racial, geographic, and gender-specific efforts to better identify and serve high-risk groups.

Dr. D’Orsogna says: “The third wave of overdose deaths began in 2013 with the entry of fentanyl into the illicit drug market. While overdose deaths have steadily increased since then, the 2020 pandemic year saw a significant increase in deaths in many states.”

Dr. Böttcher adds: “Perhaps most surprising to us were the results for the District of Columbia. Here, the 2020 fentanyl-induced mortality rate was 134 deaths per 100,000 black male residents, but only 14 deaths per 100,000 white male residents. These disparities existed before the pandemic and are also seen in other states, such as Illinois or Missouri.”

Dr. Chou notes: “To effectively combat the drug epidemic, given the wide heterogeneity of mortality rates, it is essential that we conduct more studies at the local level and better understand the unique needs of specific groups, as well as the ways in which culture, socio-economic factors, and geography circumstances influence substance use.”

Magazine reference

  1. D’Orsogna MR, Böttcher L, Chou T (2023) Fentanyl-driven acceleration of racial, gender, and geographic disparities in drug overdose deaths in the United States. PLOS Health Glob 3(3): e0000769. DOI: 10.1371/journal.pgph.0000769