Differences in Opioid Overdose Mortality Rates Among Middle-Aged Adults by Race/Ethnicity and Sex, 1999-2018

Abstract

Objectives: The types of opioids abused in the United States have changed from prescription opioids to heroin to fentanyl. However, the types of opioids abused may differ by demographic factors, especially among middle-aged adults. We examined national trends in opioid overdose mortality rates among middle-aged adults by race/ethnicity and sex.

Methods: Using 1999-2018 data from the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research database, we examined overdose mortality rates per 100 000 population in 2018 among adults aged 45-64 that involved natural and semisynthetic opioids, heroin, synthetic opioids (excluding methadone), and methadone. We tested for significant differences in mortality rates by race/ethnicity and sex. We plotted drug-specific trends by race/ethnicity and sex from 1999 to 2018.

Results: In 2018, non-Hispanic White adults had the highest rates per 100 000 population of natural and semisynthetic overdose mortality (men: 8.7; women: 7.9; P < .001), and non-Hispanic Black adults had the highest rates of heroin (men: 17.7; women: 5.4; P < .001) and synthetic opioid (men: 36.0; women: 11.2; P < .001) overdose mortality. Men had significantly higher overdose mortality rates than women did for deaths involving natural and semisynthetic opioids, heroin, and synthetic opioids, but not methadone. From 1999 to 2018, mortality rates increased sharply for heroin and synthetic opioids, increased modestly for natural and semisynthetic opioids, and decreased for methadone. The greatest increases were among non-Hispanic Black men for heroin overdose (3.3 in 1999 to 17.7 in 2018) and synthetic opioid overdose (0.1 in 1999 to 36.0 in 2018).

Conclusions: Policy making should consider unique subgroup risks and alternative trajectories of opioid use other than people being prescribed opioids, developing opioid use disorder, subsequently moving to heroin, and then to fentanyl.

Keywords: Black or African American; Hispanic or Latino; White; mortality; opioid overdose.

Figure 1

Overdose mortality rates involving opioids among adults aged 45-64, by sex, United States, 2018. Natural opioids include drugs such as morphine and codeine, and semisynthetic opioids include drugs such as oxycodone, hydrocodone, hydromorphone, and oxymorphone. Heroin is an illicit opioid synthesized from morphine. Synthetic opioids (excluding methadone) include drugs such as fentanyl, fentanyl analogues, and tramadol. Methadone is a synthetic opioid commonly prescribed for the treatment of opioid use disorder. Except for overdose mortality rates involving methadone, all differences by sex were significant at P < .001 using the Pearson χ² test with Bonferroni corrections to compare differences. Data source: Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research.

Figure 2

Overdose mortality rates involving natural and semisynthetic opioids among adults aged 45-64, United States, 1999-2018. Natural opioids include drugs such as morphine and codeine, and semisynthetic opioids include drugs such as oxycodone, hydrocodone, hydromorphone, and oxymorphone. Mortality rates may be unreliable when the death count is <20. The following subgroups had death counts <20 for the years specified: non-Hispanic Black women (1999) and Hispanic/Latina women (1999, 2000, and 2001). Data source: Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research.

Figure 3

Overdose mortality rates involving heroin among adults aged 45-64, United States, 1999-2018. Heroin is an illicit opioid synthesized from morphine. Mortality rates may be unreliable when the death count is <20. The following subgroups had death counts <20 for the years specified: non-Hispanic Black women (1999-2001) and Hispanic/Latina women (1999-2007 and 2009-2010). Data source: Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research.

Figure 4

Overdose mortality rates involving synthetic opioids among adults aged 45-64, United States, 1999-2018. Synthetic opioids (excluding methadone) include drugs such as fentanyl, fentanyl analogues, and tramadol. Mortality rates may be unreliable when the death count is <20. The following subgroups had death counts <20 for the years specified: non-Hispanic Black men (1999-2005 and 2008), Hispanic/Latino men (1999-2005 and 2007-2008), non-Hispanic Black women (1999-2005), and Hispanic/Latina women (1999-2008). Data source: Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research.

Figure 5

Overdose mortality rates involving methadone among adults aged 45-64, United States, 1999-2018. Methadone is a synthetic opioid commonly prescribed for the treatment of opioid use disorder. Mortality rates may be unreliable when the death count is <20. The following subgroups had death counts <20 for the years specified: non-Hispanic Black men (1999-2000), Hispanic/Latino men (2000-2002), non-Hispanic Black women (1999-2001), and Hispanic/Latina women (1999-2002). Data source: Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research.