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. 2022 May 2;12(5):e053686.
doi: 10.1136/bmjopen-2021-053686.

Epidemiological trends in opioid-only and opioid/polysubstance-related death rates among American Indian/Alaska Native populations from 1999 to 2019: a retrospective longitudinal ecological study

Fares Qeadan  1 , Erin F Madden  2 , Nana A Mensah  3 , Benjamin Tingey  4 , Jalene Herron  5 , Alexandra Hernandez-Vallant  5 , Kamilla L Venner  5 , Kevin English  6 , Amruta Dixit  6
Affiliations

Epidemiological trends in opioid-only and opioid/polysubstance-related death rates among American Indian/Alaska Native populations from 1999 to 2019: a retrospective longitudinal ecological study

Fares Qeadan et al. BMJ Open. .

Abstract

Objectives: The rate of drug overdose deaths in the USA has more than tripled since the turn of the century, and rates are disproportionately high among the American Indian/Alaska Native (AI/AN) population. Little is known about the overall historical trends in AI/AN opioid-only and opioid/polysubstance-related mortality. This study will address this gap.

Design: This is a retrospective longitudinal ecological study.

Setting: US death records from 1999 to 2019 using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research.

Participants: US non-Hispanic AI/AN people age 12 years and older.

Measures: The primary outcomes, identified via the 10th revision of the International Statistical Classification of Diseases and Related Health Problems codes, included overdose deaths due to (1) opioids only, opioids in combination with any other substance, all-opioid related overdoses; (2) combinations of opioids and alcohol, opioids and methamphetamine, opioids and cocaine, opioids and benzodiazepines; and (3) specific types of opioids.

Results: From 1999 to 2019, opioid-only mortality rates increased from 2.8 to 15.8 per 100 000 (p<0.001) for AI/AN women and 4.6 to 25.6 per 100 000 (p<0.001) for AI/AN men. All opioid-related mortality rates increased significantly (p<0.001) from 5.2 to 33.9 per 100 000 AI/AN persons, 3.9 to 26.1 for women and 6.5 to 42.1 for men. AI/AN also exhibited significant increases in mortality rates due to opioids and alcohol, opioids and benzodiazepines, opioids and methamphetamine, and AI/AN men experienced substantial increases in mortality due to opioids and cocaine. Mortality rates by individual opioid types increased significantly over time for heroin, natural and semi-synthetic (prescription), and synthetic opioids (fentanyl/fentanyl analogues) other than methadone.

Conclusions: These findings highlight magnification over time in opioid-related deaths and may point to broader systemic factors that may disproportionately affect members of AI/AN communities and drive inequities.

Keywords: epidemiology; public health; substance misuse.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Trends in opioid death rates among US non-Hispanic American Indian/Alaska Native 12 and older by opioid-only (no other substances), opioid/polysubstance (opioids and at least one other substance) and all opioid-related cases (sum of opioid-only and opioid/polysubstance). Opioid-only (underlying: X40-44, X60-64, X85, Y10-Y14; multiple: T40.0, T40.1, T40.2, T40.3, T40.4, T40.6); opioid/polysubstance (underlying: R78.0, X40-45, X60-65, X85, Y10-Y15; multiple: T40.0, T40.1, T40.2, T40.3, T40.4, T40.6 and T40.5, T42.4, T43.6, T51.0, T51.1, T51.9); all-opioid related: sum of ‘opioid-only’ and ‘opioid/polysubstance’.
Figure 2
Figure 2
Trends in opioid combination* death rates among US non-Hispanic American Indian/Alaska Native 12 and older by substance combination type. Opioids and methamphetamine (underlying: X40-44, X60-64, X85, Y10-Y14; multiple: T40.0, T40.1, T40.2, T40.3, T40.4, T40.6 and T43.6); opioids and cocaine (underlying: X40-44, X60-64, X85, Y10-Y14; multiple: T40.0, T40.1, T40.2, T40.3, T40.4, T40.6 and T40.5); opioids and benzodiazepines (underlying: X40-44, X60-64, X85, Y10-Y14; multiple: T40.0, T40.1, T40.2, T40.3, T40.4, T40.6 and T42.4); opioids and alcohol (underlying: R78.0, X40-45, X60-65, X85, Y10-Y15; multiple: T40.0, T40.1, T40.2, T40.3, T40.4, T40.6 and T51.0, T51.1, T51.9).
Figure 3
Figure 3
Trends in opioid death rates among US non-Hispanic American Indian/Alaska Native 12 and older by individual opioid types*. *Heroin (underlying: X40-44, X60-64, X85, Y10-Y14; multiple: T40.1); natural and semi-synthetic (prescription) opioids (underlying: X40-44, X60-64, X85, Y10-Y14; multiple: T40.2); methadone (underlying: X40-44, X60-64, X85, Y10-Y14; multiple: T40.3); synthetic opioids other than methadone (underlying: X40-44, X60-64, X85, Y10-Y14; multiple: T40.4).
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References

    1. Hedegaard H, Miniño AM, Warner M. Drug overdose deaths in the United States, 1999-2018, 2020. - PubMed
    1. Jalal H, Buchanich JM, Roberts MS, et al. . Changing dynamics of the drug overdose epidemic in the United States from 1979 through 2016. Science 2018;361::eaau1184. 10.1126/science.aau1184 - DOI - PMC - PubMed
    1. Mack KA, Jones CM, Ballesteros MF. Illicit Drug Use, Illicit Drug Use Disorders, and Drug Overdose Deaths in Metropolitan and Nonmetropolitan Areas - United States. MMWR Surveill Summ 2017;66:1–12. 10.15585/mmwr.ss6619a1 - DOI - PMC - PubMed
    1. Centers for Disease Control and Prevention, National Center for Health Statistics . Multiple cause of death 1999-2019 on CDC wonder online database, released in 2020. data are from the multiple cause of death files, 1999-2019, as compiled from data provided by the 57 vital statistics jurisdictions through the vital statistics cooperative program.. Available: http://wonder.cdc.gov/mcd-icd10.html [Accessed 02 Apr 2021].
    1. Tipps RT, Buzzard GT, McDougall JA. The opioid epidemic in Indian country. J Law Med Ethics 2018;46:422–36. 10.1177/1073110518782950 - DOI - PubMed

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