Racial Disparities in Buprenorphine Access for Unintentional Opioid Overdoses

Recent trends in unintentional opioid overdoses show a pattern of higher deaths among nonwhite and older populations as well as the increased presence of fentanyl. These study findings were published in JAMA Health Forum as a research letter.

For this study, investigators from Northwestern University sourced data of unintentional opioid overdose deaths in Illinois from 2017 to 2020 from the Centers for Disease Control and Prevention State Unintentional Drug Overdose Reporting System. These data covered 42 counties or 91% of the state. Data were binned into 6 month intervals and trends over time were assessed and compared with pre and post COVID-19 pandemic time periods.

During the study period, there were 6058 opioid overdose deaths. These deaths occurred in individuals aged mean 42.0 (SD, 12.8) years, who were mostly men (73.7%), White (52.9%); 13.9% had been receiving opioid disorder treatment, 10.8% had a previous overdose, and 60.3% overdosed in their own home.

It was noted that over time, decedents were increasingly Black and Hispanic and older than 60 years of age.

Recent touchpoint encounters increased from 11.8% at the end of 2019 to 13.5% at the beginning of 2020. The investigators found that “despite the higher rates of” touchpoint encounters, during the beginning of the COVID-19 pandemic, there was a lower percentage of decedents  with a previous overdose (8.6% vs 11.7%) or treatment for opioid use disorder (11.0% vs 14.4%), respectively.

The presence of fentanyl increased over time from 60.8% at the end of 2017 to 82.1% at the beginning of 2020. Prescription opioid positivity remained stable during this time.

At the beginning of the pandemic (January-June 2020), 61.2% of deaths occurred at home with a bystander present (50.3%). This was similar to preceding trends.

Compared with the end of 2019, the beginning of the pandemic had marginally lower rates of bystander cardiopulmonary resuscitation (14.4% vs 16.1%), transport to the emergency department (23.8% vs 28.3%), and administration of naloxone (31.8% vs 34.0%).

This study may have been limited as data relied on death certificates and medical examiner reports which may be incomplete.

The important trends to note from these data were the increasing percentage of nonwhite and older decedents as well as the ever increasing presence of fentanyl in overdose deaths, the investigators wrote. Increased access to fentanyl test strips and take home naloxone are needed, the researchers believe, especially among individuals with key touchpoint encounters. They suggested that bystanders who have a close contact with an opioid user should be educated and equipped to use interventions in an overdose situation.

Reference

Kim HS, Feinglass J, McCarthy DM, Lank PM, Mason M. Unintentional Opioid Overdose Death Characteristics in Illinois Before and During the COVID-19 Era, 2017 to 2020.JAMA Health Forum. 2021;2(11):e213699. doi:10.1001/jamahealthforum.2021.3699