More than 100,000 people in the U.S. died from unintended drug overdoses in 2021, according to the Centers for Disease Control and Prevention.
That is a 15% increase over the 91,799 lives lost in 2020, which was a record increase of 30% over 2019.
With COVID-19-related deaths in the U.S. surpassing 380,000 in both 2020 and 2021, it is easy to overlook drug overdose deaths. Yet, we must not miss or ignore the fact that the epidemic of drug overdoses we have witnessed for decades continues to escalate.
Just like the summer of 2021 when researchers broke down the COVID-19 infection and death rates by county looking for social factors, we need to look more closely at overdose statistics by asking: Who is dying? Where are they dying? What are the contributing factors? And what can be done?
The CDC’s July 19, 2022, report on drug overdose deaths looks at the social determinants that contributed to the increase in unintended overdose deaths in 25 states and the District of Columbia.
While the total overdose mortality rate increased by 30% in 2020, the rate for African Americans went up by 44% and for Native Americans by 39%. By comparison, whites, Asians and Hispanics only saw an increase of about 22% each.
In 2020, the country witnessed 39 deaths per 100,000 African Americans, 36 deaths per 100,000 Native Americans and 31 deaths per 100,000 whites. In 2019, the rate for all three groups was around 26 per 100,000.
Two years ago, the nation saw a radical shift in African American and Native American overdose deaths. The hardest hit demographic was African Americans between the age of 15 and 24 who saw an increased death rate of 86%, compared to 34% among whites in the same age range.
So, what explains the disproportionate mortality rates?
In recent years, the primary explanation has been a combination of isolation resulting from lockdowns, economic hardships and lack of access to substance abuse programs.
This may be true, as minority communities were hit hardest by economic challenges resulting from extended COVID-19 lockdowns. Nevertheless, the root causes are much deeper.
In a county-by-county analysis of the CDC’s data, specific drugs and drug usage patterns did not appear to contribute to a rise in different demographics, as 78% of white, 77% of Hispanic and 74% of African American overdose deaths involved people with a history of substance abuse.
These totals would be expected for unintentional overdoses and are similar among different racial demographics.
What stands out is that insufficient mental health and substance abuse treatment options and a lack of economic opportunity tends to align with demographic differences in overdose deaths.
For example, only 8.3% of African Americans who died of overdoses from 2019-2020 had been involved in substance abuse treatment programs, compared to 10.2% of Hispanics, 10.7% of Native Americans, 12.9% of Asian and Pacific Islanders, and 16.4% of whites.
This suggests that mental health services and substance abuse treatment programs are either not available or underutilized in African American communities.
As whites had the highest rate of substance use problem and among the lowest overall mortality rate, these programs appear to slow the death rate and account for the lower mortality rate among whites.
Unfortunately, the report focused upon death rates and not causations related to treatment modalities. The impact of limited access to these services and programs needs to be studied further.
Economic inequality appears to contribute to the overdose rate, as well. Counties with the highest rates of economic inequality saw an increased mortality rate of 46.5%, compared to counties with a low inequality rate which witnessed an increase of 19%.
It is unclear if this is primarily an economic factor or if it could be linked to depression caused by the lack of economic opportunity.
While economic inequality was a greater contributing factor than racial demographic of specific counties, this is difficult to tease out because predominantly African Americans communities are more likely to face economic inequality than predominantly white communities.
The data provides some concrete information on the social determinants that lead to unintended overdose deaths. Access to substance abuse resources and economic opportunity are two keys to battling this growing epidemic.
Further study should be conducted at the county level, looking at what impact local schools, churches and community centers have on the mortality rate. This will give communities a list of best practices to help reduce the number of overdose deaths.
In addition, government leaders and the moral community need to acknowledge that this data clearly shows a racial bias in the distribution of social resources and opportunities which are key factors in preventing unintentional overdose deaths.
Community leaders need to ask why the disproportionate distribution of resources and the continuation of significant economic inequality persists.
The CDC’s report illustrates that community leaders and government officials are failing at-risk demographics. At best, this is the result of social apathy, but more likely it is a blatant example of systemic racism.
It is time that we push ourselves and our leaders to do more to curb the plague of overdose deaths that are inflicting pain on our communities.
Senior Staff Chaplain and Clinical Ethicist at the Baptist Health Medical Center in Little Rock, Arkansas.
