Nature of Opioids Implicated in Deaths Have Shifted for Blacks, Whites Since 1979

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Long-term trends for opioid-related mortality in the United States were found to have occurred in 3 successive waves.
Long-term trends for opioid-related mortality in the United States were found to have occurred in 3 successive waves.

Causes of opioid-related deaths in the United States have evolved from 1979 to 2015 for both white and black populations, according to a study published in Epidemiology.

With the goal of understanding how the opioid epidemic has affected white and black populations uniquely, researchers gathered multiple-cause-of-death data to tabulate deaths from opioid overdose for each group between 1979 and 2015. Long-term trends for opioid-related mortality in the United States were found to have occurred in 3 successive waves. The first wave (1979-1993) of the epidemic affected both white and black populations and was driven by heroin. In the second wave (1993-2010), an increase in opioid-related mortality among the white population was driven by natural/semisynthetic opioids (ie, codeine and hydrocodone). Concurrently, there was no increase in mortality among the black population. The third wave (2010-2015), which saw rapid increases in opioid-related mortality in both blacks and whites, was driven by heroin and synthetic opioids such as fentanyl.

Researchers emphasized that recent death rates from heroin and synthetic opioids have reached unprecedented levels. Heroin use rates are currently increasing at 31% per year for whites and 34% for blacks, and synthetic opioid use rates are increasing at 79% and 107%, respectively.

Several limitations to this study were noted, including the possibility that opioid mortality is underreported in certain parts of the country, as well as a potential underestimation of fentanyl mortality rates.

“The different patterns in the opioid epidemic by race suggest the need for targeted policy interventions to account for the distinctive pathways to addiction,” noted the study authors. “A better understanding of racial differences and how they relate to the use of other drugs, place of residence, and socioeconomic status, is necessary to improve health interventions and rehabilitation programs across the country.”

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Reference

Alexander MJ, Kiang MV, Barbieri M. Trends in black and white opioid mortality in the United States, 1979-2015 [published online May 29, 2018]. Epidemiology. doi: 10.1097/EDE.0000000000000858

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