Cocaine and Psychostimulant-involved Overdose Deaths Disproportionately Affect Racial and Ethnic Minority Groups

It is an important time to recognize the importance of addressing health equity to help end the drug overdose epidemic.

Health inequities can contribute to negative health outcomes, including increased overdose deaths, among racial and ethnic minority populations including Black, American Indian/Alaska Native, and Hispanic persons. Clinicians, public health professionals, policy makers, and other community members can work together to promote health equity, reduce poor health outcomes, and prevent health disparities.

October marks National Youth Substance Use Prevention Month, a time for Americans to renew our commitment to end the drug overdose epidemic that has claimed nearly 850,000 lives over the last 20 years. Research shows that drug overdose deaths involving stimulants like cocaine and psychostimulants with abuse potential (e.g., methamphetamine) have increased significantly and are disproportionately affecting racial and ethnic minority populations.

• From 2004 to 2019, death rates for overdoses involving cocaine were generally higher among Black persons than other racial and ethnic groups, and death rates for overdoses involving psychostimulants were generally higher among American Indian/Alaska Native (AI/AN) persons than among other racial and ethnic groups.
• From 2013 to 2019, most racial and ethnic groups experienced increases in rates of overdoses involving both cocaine and opioids and rates of overdoses involving both psychostimulants and opioids.

Which drugs are considered psychostimulants with abuse potential?

• Methamphetamine, which is an illegal stimulant that can be smoked, snorted, injected, or orally ingested
• MDMA, also known as ecstasy, which is an illegal stimulant and is usually taken orally
• Prescription stimulants, which are prescribed for conditions such as attention deficit hyperactivity disorder (ADHD) or depression, and can be taken orally, snorted, or injected

Why are stimulant-involved overdose deaths increasing? Why are racial and ethnic minority populations more affected than others?

The disproportionate increase in stimulant-involved death rates among Black and AI/AN persons may partly be due to health inequities like unequal access to substance use treatment and treatment biases.

Overall factors that may be influencing the surge in stimulant-involved death rates include increases of:

• Supply of methamphetamine
• Use of stimulants and opioids together
• Presence of fentanyl in other illicit drugs, also known as “contamination” or “lacing” of other drugs

While these factors may have contributed to the increase of stimulant-involved overdose deaths, disparities in stimulant-involved overdose deaths among Black and AI/AN persons are not fully explained by substance use patterns. For instance, recent data show that while rates of past-year cocaine use among Black and White persons are not significantly different, cocaine-involved overdose death rates among Black persons were more than twice as high as those among White persons in 2019.

How can we promote health equity to help address the overdose epidemic?

Health equity is when everyone has the opportunity to be as healthy as possible. Together, clinicians, public health professionals, policy makers, and other community members can work to promote health equity and address structural inequities. When policies, programs, and systems that support health are equitable, poor health outcomes can be reduced, health disparities can be prevented, and all of society benefits.

We can all promote health equity for racial and ethnic minority groups by:

• Incorporating culturally tailored strategies and translating such treatments into languages other than English to improve participation and retention among racial and ethnic minority groups.
• Implementing structural and policy-level interventions, like equitable access to buprenorphine (a medication for opioid use disorder), and barriers to accessing treatment and other risk reduction services to address the systemic challenges that may contribute to substance use disorder.
• Increasing access to evidence-based overdose prevention and treatment efforts.
• Investing in research and implementation of cognitive behavioral therapies and treatments for non-opioid substances given the variety of substances involved in drug overdoses.
• Continuing to increase naloxone distribution and accessibility and promoting medication for opioid use disorder for persons using stimulants, particularly cocaine, given the large proportion of fatal drug overdoses that also involve opioids.