Health Disparities and Opioid-Involved Overdose Deaths: A 20-Year Retrospective Analysis

About This Grant

Despite historically lower rates of opioid-involved overdose deaths (OODs) among Blacks, the growth in opioid-involved overdose deaths among Blacks now outpaces that of Whites. The differences in OODs merit deliberate investigation to reduce the widening gap. In 2017, the U.S. Department of Health and Human Services (DHHS) declared a public health emergency and announced a 5-Point Strategy to combat the opioid epidemic that included 1) strengthening our understanding of the epidemic through better public health surveillance; 2) improving access to treatment and recovery services; 3) promoting the use of overdose-reversing drugs; 4) providing support for cutting edge research on pain and addiction; and; 5) advancing better practices for pain management (including better prescribing practices). Opioid-involved overdose deaths decreased nationally and in multiple states the year following the DHHS declaration of the opioid epidemic but was attributable solely to a decrease in OODs among non-Hispanic Whites. While the DHHS strategy is evidence-informed and holds great promise to curtail the growing opioid epidemic there are differences in implementation, and multiple states have seen a deceleration in OOD rates only among non-Hispanic Whites and significant increases among Black and Hispanics. While non-Hispanic Whites have historically had higher OOD rates based on local and national data, further investigation is needed to examine the racial and ethnic differences in recent OOD trends to frame ongoing and future intervention efforts to ensure prevention, treatment, and recovery services are being implemented and resourced. This study will examine racial differences in OODs from 2005-2024 and provide an in-depth analysis of OOD misclassification and under specification, pre- and post-2020. We will examine individual drivers as well as upstream factors contributing to OODs, leveraging multiple, large, comprehensive national datasets to better understand the nature and extent of differences in OODs, as well as identify interventions to reduce these differences. The two Specific Aims of this research are to (1) Characterize racial and ethnic differences in all opioid-involved overdose death subtypes (e.g., heroin, synthetic opioids, unspecified narcotics) from 2005 to 2024 and (2) Investigate drivers of these differences in the under specification of OODs including key upstream factors.