Race-based disparities appear in drug overdose death totals for 2020

Fentanyl, COVID-19 pandemic likely factors in 30% increase from previous year.

The increase in drug overdose deaths in 2020 disproportionately affected Black and American Indian/Alaska native (AI/AN) populations across half the country.

There were 91,799 drug overdose deaths across the nation in 2020, up about 30% from the year before, according to a new study by the federal Centers for Disease Control and Prevention (CDC). Likely contributors included the use of illicitly manufactured fentanyl, and disruptions to treatment and prevention due to the COVID-19 pandemic.

The new report listed overall drug overdose death rate increases in 25 states and the District of Columbia, with relative rate increases highest among Black (44%) and AI/AN people (39%). Among White people, the rate increased by 22%. The findings underscore the escalating overdose crisis on Black, AI/AN and Hispanic people, the report said.

“Integration of evidence-based substance use disorder treatment with culturally tailored traditional practices, spirituality, and religion might improve treatment acceptance among Black and AI/AN populations,” the report said. CDC suggested using culturally specific awareness campaigns, use in nontraditional and community settings, and trusted community messengers to connect people with treatment and harm reduction services, while reducing stigma and mistrust and improving access to care.

By the numbers

Within racial and ethnic groups, Black males aged 45 to 64 years had a death rate almost seven times greater than White males of the same age, while AI/AN females aged 25 to 44 years had a death rate nearly twice that of White females of the same age in 2020, according to the CDC figures. The agency called the disparities one of the critical findings in the analysis.

Younger people also fared badly in the drug overdose epidemic when measuring largest relative rate increases. Among Black people, deaths for people aged 15 to 24 years had the largest annual increase – 86% -- while White people in the same age range saw an increase of 34%. For AI/AN people, year-one-year deaths rose 49% for those aged 25 to 44 years, while Hispanic males in that age range had a 47% increase in the overdose death rate in 2020.

Critical findings

The CDC report listed four other critical findings on health disparities and inequities:

  • Drug overdose deaths increased with increasing county-level income inequality. Particularly among Black people the overdose death rate was more than twice as high in areas with the highest income inequality, as in areas with the lowest income inequality.
  • Evidence of previous substance use treatment was lowest among Black decedents and about half that of White decedents.
  • Overdose death rates were highest in counties with higher potential substance use treatment capacity and mental health providers. Rates were more pronounced among Black and AI/AN people than among White people, likely due to inequities in access to mental health and substance use care, including medications for opioid use disorder.
  • Evidence of naloxone administration was low in all groups.

The report, “Vital Signs: Drug Overdose Deaths, by Selected Sociodemographic and Social Determinants of Health Characteristics — 25 States and the District of Columbia, 2019–2020,” was published July 19. The states involved were: Alaska, Connecticut, Delaware, Georgia, Kentucky, Maine, Massachusetts, Minnesota, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, Ohio, Oklahoma, Rhode Island, Tennessee, Utah, Vermont, Virginia, West Virginia, Illinois, Missouri, Pennsylvania, and Washington.