Disparities in Opioid Overdose Death Trends by Race/Ethnicity, 2018–2019

From the HEALing Communities Study

Marc R. Larochelle, MD, MPH; Svetla Slavova, PhD, Elisabeth D. Root, PhD; Daniel J. Feaster, PhD; Patrick J. Ward, PhD, MPH; Sabrina C. Selk, ScD; Charles Knott, MPA; Jennifer Villani, PhD, MPH; Jeffrey H. Samet, MD, MA, MPH


Am J Epidemiol. 2021;111(10):1851-1854. 

In This Article

Abstract and Introduction


Objectives: To examine trends in opioid overdose deaths by race/ethnicity from 2018 to 2019 across 67 HEALing Communities Study (HCS) communities in Kentucky, New York, Massachusetts, and Ohio.

Methods: We used state death certificate records to calculate opioid overdose death rates per 100 000 adult residents of the 67 HCS communities for 2018 and 2019. We used Poisson regression to calculate the ratio of 2019 to 2018 rates. We compared changes by race/ethnicity by calculating a ratio of rate ratios (RRR) for each racial/ethnic group compared with non-Hispanic White individuals.

Results: Opioid overdose death rates were 38.3 and 39.5 per 100 000 for 2018 and 2019, respectively, without a significant change from 2018 to 2019 (rate ratio = 1.03; 95% confidence interval [CI] = 0.98, 1.08). We estimated a 40% increase in opioid overdose death rate for non-Hispanic Black individuals (RRR = 1.40; 95% CI = 1.22, 1.62) relative to non-Hispanic White individuals but no change among other race/ethnicities.

Conclusions: Overall opioid overdose death rates have leveled off but have increased among non-Hispanic Black individuals.

Public Health Implications: An antiracist public health approach is needed to address the crisis of opioid-related harms. (Am J Public Health. 2021;111(10):1851–1854. https://doi.org/10.2105/AJPH.2021.306431)


Opioid overdose deaths continue to increase in the United States, reaching 49 860 in 2019, the highest ever recorded.[1] Non-Hispanic White individuals were disproportionately affected in the wave of prescription opioid deaths at the turn of the century; however, recent increases driven by heroin and fentanyl have been greater for non-Hispanic Black and Hispanic individuals.[2,3] Racial inequities in US drug policy are well chronicled.[4] These inequities include more severe criminal penalties for crack cocaine, more commonly used by Black individuals, compared with those for powder cocaine, more commonly used by non-Hispanic White individuals. Furthermore, the increase in opioid overdose deaths among non-Hispanic White individuals was associated with a shift toward a public health approach encompassing compassion and treatment.[4]

The Helping to End Addiction Long-term Communities Study (HCS) is an ongoing multisite, parallel-group, cluster-randomized, wait list–controlled trial in 67 communities disproportionately affected by opioid overdose deaths in 4 states (Kentucky, Massachusetts, New York, and Ohio).[5] HCS, the largest addiction implementation study ever conducted, is evaluating the impact of a community engagement intervention to reduce opioid overdose deaths. In the planning stage, community coalitions requested data by race/ethnicity to focus on equity. HCS created the infrastructure to provide data on opioid overdose deaths by race/ethnicity at the community level in a more timely and detailed manner than available through publicly available resources.[6] We reported trends in opioid overdose deaths by race/ethnicity from 2018 to 2019 during the preintervention baseline period in the 67 HCS communities. These trends directly informed community intervention planning.