Unintentional Drug Overdoses Take a Toll Across the U.S. Unequally

A new study by researchers at Columbia University Mailman School of Public Health reveals significant racial and sex disparities in drug overdose mortality rates. Both Black men and Black women have been disproportionately impacted by overdose deaths, with their mortality rates rising sharply compared to their White counterparts, the study finds.

The findings, which expand scientific understanding of how race, sex, and regional factors intersect to affect overdose outcomes, are published in the journal JAMA Network Open.

“Efforts to reduce drug-related mortality must address the specific needs of marginalized communities, especially Black men,” said Kechna Cadet, PhD, postdoctoral researcher in the Department of Epidemiology. “Addressing these disparities requires a comprehensive, multifaceted approach that targets social, economic, physical, and policy risk factors.”

The researchers examined trends in drug poisoning mortality between Black men, Black women, White men, and White women across all 50 states from 2010 to 2020. Data on unintentional drug poisoning deaths was sourced from the CDC’s Injury Statistics Query and Reporting System. The analysis included 518,724 fatal drug poisoning cases, broken down as follows: 46,776 Black men, 20,087 Black women, 150,405 White women, and 301,456 White men. The study accounted for 11,820,781 years of potential life lost during the 10-year period.

For the entire period, Black men had the highest mean age-adjusted mortality rate at 23 deaths per 100,000, followed by White men at 22 per 100,000, with lower rates for White women (12 per 100,000) and Black women (9 per 100,000). Black male mortality rates saw the most dramatic increases, particularly in Maryland (+485 percent) and the District of Columbia (+360 percent). In contrast, White female mortality rates declined in states like Alaska (-23 percent) and Wyoming (-20 percent) and Oklahoma (-19 percent).

“Our goal was to identify the specific sociodemographic groups and regions that have faced the highest levels of inequality and are in urgent need of intervention,” said  Cadet.

The study found that in 2016, Black male overdose mortality rates surpassed those of White men, with Black male rates nearly 60 percent higher by 2020. Similarly, Black women saw a steady increase in mortality rates, surpassing those of White women by 2019.

The opioid overdose epidemic, which has caused nearly one million deaths in the U.S. since its onset, remains a leading contributor to the country’s declining life expectancy. In 2021 alone, roughly 107,000 lives were lost to overdoses involving fentanyl, heroin, and cocaine.

Historically, the majority of opioid-related deaths have been among White individuals. However, overdose rates involving opioids and cocaine have plateaued among non-Hispanic White populations while rising among Black and Hispanic groups. In addition, men have experienced consistently higher overdose rates than women.

“Our analysis of intersectional race and sex disparities over the past decade offers crucial insights for directing much needed resources such as harm reduction services and tailored treatment programs to the populations most in need of urgent targeted interventions to decrease unintentional drug overdoses,” said Silvia Martins, MD, PhD, professor of Epidemiology at Columbia Mailman School, and senior author of the study.

Bianca Smith, a co-author of the study from Johns Hopkins Bloomberg School of Public Health, also contributed to the research.

The study reported in this press release was supported by the National Institute of Drug Abuse of the National Institutes of Health, under grant numbers DA031099, DA007292, and DA059376. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.