2 X
In counties with more income inequality, overdose death rates for Black people were more than two times as high as in counties with less income inequality in 2020.
7 X
Overdose death rates in older Black men were nearly seven times as high as those in older White men in 2020.
2 X
Overdose death rates for younger American Indian and Alaska Native (AI/AN) women were nearly two times those of younger White women in 2020.

Overview

Drug overdose data show troubling trends and widening disparities between different population groups. In just one year, overdose death rates (number of drug overdose deaths per 100,000 people) increased 44% for Black people and 39% for American Indian and Alaska Native (AI/AN) people. Most people who died by overdose had no evidence of substance use treatment before their deaths. In fact, a lower proportion of people from racial and ethnic minority groups received treatment, compared with White people. Some conditions in the places where people live, work, and play can widen these disparities. For instance, areas with greater income inequality—a larger income gap between the rich and the poor—have higher rates of overdose deaths. Comprehensive, community-based prevention and response efforts should incorporate proven, culturally responsive actions that address disparities in drug overdose deaths and the inequities that contribute to them.

  • Increasing access to proven treatment for all people who have substance use disorder(s) is a critical part of their care and recovery.
  • Harm reduction services can further reduce overdoses and save lives. Harm reduction services can include naloxone, fentanyl test strips, and referral to substance use disorder treatment. Syringe services programs can serve as a valuable way to reach people who inject drugs and provide them with overdose prevention education and opportunities to link to substance use disorder treatment.

Drug overdose death disparities are widening at the same time as a record-breaking 92,000 lives were lost to drug overdoses during 2020. More must be done to prevent overdoses and deaths.

Overview

Drug overdose data show troubling trends and widening disparities between different population groups. In just one year, overdose death rates (number of drug overdose deaths per 100,000 people) increased 44% for Black people and 39% for American Indian and Alaska Native (AI/AN) people. Most people who died by overdose had no evidence of substance use treatment before their deaths. In fact, a lower proportion of people from racial and ethnic minority groups received treatment, compared with White people. Some conditions in the places where people live, work, and play can widen these disparities. For instance, areas with greater income inequality—a larger income gap between the rich and the poor—have higher rates of overdose deaths. Comprehensive, community-based prevention and response efforts should incorporate proven, culturally responsive actions that address disparities in drug overdose deaths and the inequities that contribute to them.

  • Increasing access to proven treatment for all people who have substance use disorder(s) is a critical part of their care and recovery.
  • Harm reduction services can further reduce overdoses and save lives. Harm reduction services can include naloxone, fentanyl test strips, and referral to substance use disorder treatment. Syringe services programs can serve as a valuable way to reach people who inject drugs and provide them with overdose prevention education and opportunities to link to substance use disorder treatment.

Drug overdose death disparities are widening at the same time as a record-breaking 92,000 lives were lost due to drug overdoses during 2020. More must be done to prevent overdoses and deaths.

Challenges
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Racial and ethnic minority groups have less access to proven treatments for substance use disorders. This difference is not simply because of a lack of availability of services. Communities with higher capacity to provide care had the highest death rates, and this pattern was even worse for Black and AI/AN people. Income inequalities, often negatively impacting people from racial and ethnic minority groups at a greater level, can lead to lack of stable housing, reliable transportation, and health insurance.  This makes it even more difficult for people to access treatment and other support services.

In addition, overdoses are becoming more common and deadly. Mixing drugs or using more than one drug (polysubstance use) and the increasing spread of illicitly manufactured fentanyls (IMFs) in the drug supply are major concerns. It is critical for prevention efforts to address polysubstance use while also working to reduce historical health inequities, promote primary prevention, and expand proven treatment, recovery support services, and harm reduction strategies. Public health departments can bring together criminal justice, health care, social services, employers, and government partners to focus on comprehensive efforts that have the greatest potential to prevent overdose.

Overdose Deaths by Race and Ethnicity Over One Year

Overdose deaths increased more for certain groups than others from 2019 to 2020.

Infographic depicting overdose deaths increased more for certain groups than others from 2019 to 2020.
Infographic depicting overdose death statistics

Overdose Death Disparities Are on the Rise. What Now?

Identify and address cultural, economic, and structural reasons that increase risk for overdose and prevent certain groups from getting and staying in treatment and recovery.  

Infographic depicting cultural, economic, and structural reasons that increase risk for overdose.
What Can Be Done

To Advance Health Equity

Drug overdoses are preventable. The growing overdose crisis, particularly among people from racial and ethnic minority groups, requires tailored prevention and treatment efforts. These efforts should be designed to restore optimal health for all. Public health professionals, healthcare providers, policy makers, and communities can consider:

  • Improving access to treatment and recovery support services by offering telehealth and similar options that help people start and continue treatment and care over time. This is especially important for people from racial and ethnic minority groups, who encounter more barriers to accessing these vital services. Expanding insurance coverage can help.
  • Offering structural support such as housing assistance, transportation assistance, and childcare to help reduce barriers to accessing and staying in treatment and recovery.
  • Combining culturally appropriate traditional practices, spirituality, and religion, when appropriate, with proven substance use disorder treatment.
  • Creating culturally tailored campaigns that help raise awareness and reduce stigma around treatment and recovery.
  • Offering support groups and opportunities for community connection to help reduce stigma and mistrust.
  • Reducing criminalization of substance use disorders.
  • Linking people to treatment from a variety of settings (such as primary care, syringe services programs, and healthcare settings during incarceration) and through trusted messengers, which helps people to continue treatment over time.
  • Improving access to programs that address past and prevent future trauma and other risk factors for substance use.
Photo collage of people collaborating.

Drug overdoses are preventable. The growing overdose crisis, particularly among racial and ethnic minority groups, requires prevention and treatment efforts that are tailored to restore optimal health for all. Public health professionals, healthcare providers, policy makers, and communities can consider:

  • Improving access to treatment and recovery support services by offering telehealth and similar options that help people start and continue treatment and care over time, especially among racial and ethnic minority groups who encounter more barriers to accessing these vital services. Expanding insurance coverage can help.
  • Offering structural support such as housing assistance, transportation assistance, and childcare can help reduce barriers to accessing and staying in treatment and recovery.
  • Combining culturally appropriate traditional practices, spirituality, and religion, when appropriate, with proven substance use disorder treatment.
  • Creating culturally tailored campaigns that help raise awareness and reduce stigma around treatment and recovery.
  • Offering support groups and opportunities for community connection to help reduce stigma and mistrust.
  • Reducing criminalization of substance use disorders.
  • Linking people to treatment from a variety of settings (such as primary care, syringe services programs, and healthcare settings during incarceration) and through trusted messengers, which helps people to continue treatment over time.
  • Improving access to programs that address past and prevent future trauma and other risk factors for substance use.
Photo collage of people collaborating.

To Prevent Overdose Death

Prevent Overdose

  • Reduce adverse childhood experiences (which can increase risk for substance use and use disorder) and root causes of health disparities.
  • Raise awareness about the dangers of illicitly manufactured fentanyls and using more than one drug.
  • Reduce stigma around seeking substance use disorder treatment, harm reduction, and recovery support services.

Treat Substance Use Disorder

  • Link people to care and help people start and stay in treatment from different settings.
  • Improve access and reduce barriers to proven treatment for substance use disorders (i.e., medication for opioid use disorder).
  • Include culturally tailored traditional practices, spirituality, and religion, when appropriate, with proven substance use disorder treatment.

Support Harm Reduction

  • Expand community naloxone distribution and education, as well as prescribing and dispensing from pharmacies.
  • Expand access to harm reduction services to include distribution of naloxone, fentanyl test strips, syringe service programs that include overdose prevention efforts, and connections to same-day substance use disorder treatment.
  • Expand education about substance use and risks for overdose and overdose deaths to include employers, Medicaid and other health insurance payers, and policy makers.

Everyone can:

  • Talk to a doctor if you or someone close to you needs help for substance use.
  • Learn about naloxone, a lifesaving drug that can reverse the effects of an opioid overdose when administered in time. Ask your doctor or pharmacist for a naloxone prescription or get naloxone from local organizations if you or a loved one uses illicit drugs, has a substance use disorder, takes high-dose prescription opioids, or has other risk factors for opioid overdose.
  • Read and share resources about overdose prevention and raise awareness about the communities who are disproportionately impacted by overdose.
  • Learn more about reducing stigma, which can be a major barrier to getting help.

Prevent Overdose

  • Reduce adverse childhood experiences (which can increase risk for substance use and use disorder) and root causes of health disparities.
  • Raise awareness about the dangers of illicitly manufactured fentanyls and using more than one drug.
  • Reduce stigma around seeking substance use disorder treatment, harm reduction, and recovery support services.

Treat Substance Use Disorder

  • Link people to care and help people start and stay in treatment from different settings.
  • Improve access and reduce barriers to proven treatment for substance use disorders (i.e., medication for opioid use disorder).
  • Include culturally tailored traditional practices, spirituality, and religion, when appropriate, with proven substance use disorder treatment.

Support Harm Reduction

  • Expand community naloxone distribution and education, as well as prescribing and dispensing from pharmacies.
  • Expand access to harm reduction services to include distribution of naloxone, fentanyl test strips, syringe service programs that include overdose prevention efforts, and connections to same-day substance use disorder treatment.
  • Expand education about substance use and risks for overdose and overdose deaths to include employers, Medicaid and other health insurance payors, and policy makers.

Everyone can:

  • Talk to a doctor if you or someone close to you needs help for substance use.
  • Learn about naloxone, a lifesaving drug that can reverse the effects of an opioid overdose when administered in time. Ask your doctor or pharmacist for a naloxone prescription or get naloxone from local organizations if you or a loved one uses illicit drugs, has a substance use disorder, takes high-dose prescription opioids, or has other risk factors for opioid overdose.
  • Read and share resources about overdose prevention and raise awareness about the communities who are disproportionately impacted by overdose.
  • Learn more about reducing stigma, which can be a major barrier to getting help.