As overdose deaths exploded during the pandemic, racial disparities widened, CDC report shows

As U.S. overdose deaths soared to devastating new heights in the first year of the pandemic, racial disparities widened sharply, with rates spiking much more among Black people and American Indians and Alaska Natives than among white people, according to a federal report released Tuesday.

While overall overdose deaths increased by 30% from 2019 to 2020 — to some 92,000 lives lost — rates increased by 44% among Black individuals and 39% among American Indian and Alaska Native people, according to the report from the Centers for Disease Control and Prevention, which looked at data from 25 states and Washington.

Overdose death rates among people who are white, Asian or Pacific Islander, or Hispanic all increased by about 22%, the report found.

Overdose deaths in 2020 stood at 39 per 100,000 Black people; 36 per 100,000 American Indian or Alaska Native individuals; and 31 per 100,000 white people, the report showed. In 2019, the rates for all three groups ranged from 25 to 27 per 100,000 people.

Hispanic people — at 21 deaths per 100,000 people in 2020 — and Asian or Pacific Islander people — at 3 deaths per 100,000 — had lower rates.

Debra Houry, the director of CDC’s National Center for Injury Prevention and Control, said during a briefing Tuesday that the disparities “may partly be due to health inequities like unequal access to substance use treatment and treatment biases.” 

“Racism, a root cause of health disparities, continues to be a serious public health risk that directly affects the wellbeing of millions of Americans, and, as a result, affects the health of our entire nation,” Houry said. 

The new data underscore how the Covid-19 pandemic accelerated overdoses across demographics, by interrupting services, leaving people to use drugs alone, and possibly exacerbating the deadliness of the drug supply, experts say. But the toll was disproportionate, with Black and American Indian and Alaska Native people who use drugs seeing particularly large increases in mortality.

The CDC had already released data showing the overall jump in overdose deaths in 2020, but the new report drills into differences by race and ethnicity.

The disparities were not consistent across age groups. Black men 65 and older died from overdoses at nearly seven times the rate as older white men, the report showed. Young Black people, ages 15 to 24, had the biggest death rate increase from 2019 to 2020, at 86%, compared to 34% for white people that age. American Indian or Alaska Native women from age 25 to 44 died from overdoses at nearly twice the rate of white women in that age group.

The deaths were broadly driven by illicit fentanyl, CDC officials said, though deaths attributed to other drug types, including stimulants like methamphetamine, have also been rising in recent years.

The vast majority of people who died did not have evidence of past treatment for substance use disorder, according to the report. White people who died appeared to have higher rates of treatment than people from other races and ethnicities.

Overdose deaths had been rising for decades before the pandemic, and they continued to climb into 2021, reaching more than 107,000 that year. Disparities were emerging in the pre-pandemic years and are expected to keep growing without concentrated efforts to stem them.

Researchers outside the CDC have already released studies showing how overdose mortality changed from 2019 to 2020, with a paper published in JAMA Psychiatry in March, for example, showing that nationally, overdose mortality among Black people rose by 48.8% in 2020 versus 26.3% among white individuals.

The pace at which CDC releases finalized statistics highlights a key frustration among researchers who focus on overdose: It takes a long time for jurisdictions to report overdoses and which drugs were involved, and it takes a long time for CDC analyses to be published. Without more up-to-date data, experts say, the country doesn’t have good eyes on the overdose crisis, even as it seems to grow worse and as disparities seem to continue widening. 

Houry said CDC has been working to make more timely data available, including by releasing provisional overdose numbers after about four or five months, but noted that it takes time for medical examiners and toxicologists to complete their investigations. The agency is also providing states and coroners with more resources to improve their data reporting.

Houry said researchers were also looking at other data sources, including emergency department visits for non-fatal overdoses, to better track the health impacts of drug use.