Acceleration of regional, racial and gender disparities in drug overdoses across the United States driven by COVID-19 and fentanyl use

ObjectivesTo examine trends in drug overdose deaths by gender, race and geography in the United States during the period 2013-2020. MethodsWe used the final National Vital Statistics System multiple cause-of-death mortality files to extract crude rates by gender and race and to calculate the male-to-female ratios of crude rates between 2013 and 2020. We established 2013-2019 temporal trends for four major drug types: psychostimulants with addiction potential (T43.6, such as methamphetamines); heroin (T40.1); natural and semi-synthetic opioids (T40.2, such as those contained in prescription pain-killers); synthetic opioids (T40.4, such as fentanyl and its derivatives) through a quadratic regression and determined whether changes in the pandemic year 2020 were statistically significant. We also identified states, race and gender categories most impacted by drug overdoses. ResultsNationwide, the year 2020 saw statistically significant increases in overdoses for all drug categories except heroin, surpassing predictions based on 2013-2019 trends. Crude rates for Blacks of both genders surpassed those for Whites for fentanyl and psychostimulants in 2018 creating a gap that widened through 2020. In some regions mortality among Whites decreased while overdose rates for Blacks kept rising. The largest 2020 mortality statistic is for Black males in the District of Columbia, with a record 134 overdoses per 100,000 due to fentanyl, 9.4 times more than the fatality rate among White males. Male overdose crude rates in 2020 remain larger than those of females for all drug categories except in Idaho, Utah and Arkansas where crude rates of overdoses by natural and semisynthetic opioids for females exceeded those of males. Public Health ImplicationsDrug prevention, mitigation and no-harm strategies should include racial, geographical and gender-specific efforts, to better identify and serve at risk groups.