The Centers for Disease Control and Prevention (CDC) recently launched a report on the U.S. unintentional overdose deaths in 25 states and the Columbia district.
Rates were examined by race and ethnicity as well as county-level social determinants of health like income inequality and treatment provider availability.
BIPOC Most Affected By Overdose Deaths
The study shows that numbers rose up to about 30% for the period 2019-2020, with the highest death rates found among Black and American Indian/Alaska Native people. Data was extracted from the State Unintentional Drug Overdose Reporting System.
More specifically, for the period 2019-2020 overdose death rates increased by 44% and 39% among non-Hispanic Black (Black) and non-Hispanic American Indian or Alaska Native persons, respectively. As county-level income inequality increased, overdose rates increased, particularly among Black persons.
Significant and growing disparities were found across sex, age, and racial and ethnic subgroups. The overall results call for the implementation of an evidence-based, culturally responsive, multisectoral approach for reducing disparities in overdose rates, including addressing structural barriers and enhancing efforts such as linkage to care and harm reduction services.
"We know that health disparities play a key role in overdose death rates among people in certain racial and ethnic minority groups," said researcher and health scientist in the CDC's Division of Overdose Prevention Mbabazi Kariisa said in an interview with Medpage Today.
Unequal Access To Health Services May Explain Disproportion In Deaths Across Race And Ethnicity
Researcher Debra Houry explained that the disproportionate increase in overdose death rates among Black and AI/AN people may be partly due to health inequities such as unequal access to substance use treatment as well as treatment biases.
"Racism, a root cause of health disparities, continues to be a serious public health threat that directly affects the well-being of millions of Americans ... When policies, programs, and systems that support health are equitable, poor outcomes can be reduced, deaths can be prevented, and all of society benefits," Houry stated.
Also, opioid overdose rates in 2020 proved higher in areas with more treatment program availability compared to those with lower availability, particularly among Black individuals (34.3 per 100,000 versus 16.6 per 100,000) and AI/ANs (33.4 per 100,000 versus 16.2 per 100,000).
Facing this finding, Kariisa explained that "availability of services doesn't mean that those services are actually accessible." Lack of insurance might be a possible reason why certain minority groups could be less able to access treatment in those places, while "some of these treatment centers ... are not necessarily evenly distributed throughout the areas they live in" as well, "So transportation barriers are a factor in limiting people getting access to some of these treatment services.” Other factors like education and mistrust in the healthcare system could be reasons for non attendance, too.
The study also found that most deceased had a documented history of substance use. On the other hand, previous substance use treatment proved scarce, with Black deceased having the lowest percentage (8.3%), followed by Hispanic (10.2%) and AI/AN (10.7%).
In face of the results, Houry took telehealth as an example of an unevenly distributed treatment option: "Sometimes there is structural racism or discrimination where patients could technically be eligible for telehealth, but a provider might not think about using it with that patient ... Even if a patient is eligible for telehealth, it might not work for them because they might not have a smartphone, or they might not have a private place to do those calls."
When asked whether safe injection sites were an example of an effective harm reduction strategy, Houry responded that although such sites have been open for a while in other countries, there is no available data in the U.S. so far, so its efficacy is still to be seen. “Once there are good evaluation studies …, we'll be better poised to give more guidance on this," she said.
The researcher and study director ended the Q&A session stating that "everyone can play a role in preventing overdoses" by learning the signs of overdose and carrying naloxone with them.
When asked about the new nationwide 988 suicide prevention hotline that was recently rolled out, Houry said that it will be a very helpful tool for those suffering mental health issues or are in need to talk to somebody, considering that “people that use substances may have mental health distress or suicidality.” The tool would give them the opportunity to get someone on the other side of the line to help and “get those resources to prevent suicide."
Photo by Ümit Bulut on Unsplash
