Widening Racial Disparities in the U.S. Overdose Epidemic

Abstract

Introduction: More Americans died in 2021 from drug overdose than from vehicle accidents and firearms combined. Unlike earlier phases, the current epidemic is marked by its disproportionate impact on communities of color. This report investigates regional and substance-specific variations in racial disparities to generate possible insights into the various forces shaping these trends.

Methods: This report used data from 1999 to 2022 on opioid-related overdose deaths from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database. Racial disparities at the national, state, and substance levels were compared to describe heterogeneities in disparities trends. Data were analyzed in 2024.

Results: Overall age-adjusted overdose mortality in the U.S. increased from 6.2 to 32.7 deaths per 100,000 between 1999 and 2022. In this same time period, mortality has increased most rapidly in Black, Native, and Hispanic/Latino Americans at 249.3%, 166.3%, and 171.8%, respectively. Disparities with White populations vary regionally. The upper Midwest (i.e., Minnesota, Wisconsin) and Washington state rank highest in excessive Native overdose death; the upper Midwest and Washington, DC rank highest as Black overdose deaths. In terms of substances, deaths from polyuse of methamphetamines and opioids have been highest among Native Americans over time, whereas deaths from cocaine and opioids disproportionately impact Black Americans.

Conclusions: The opioid epidemic continues to expand, with particularly rapid acceleration in racially minoritized communities. The growing role of stimulants in opioid overdose deaths is a racialized phenomenon disproportionately impacting Black and Native Americans. Wide variation in state-level disparities suggest that structural racism impacts health in regionally specific ways, highlighting the need for regional solutions.

Figure 1.

Annual age-adjusted and race-stratified opioid-involved mortality with 95% CIs in the U.S. between 1999 and 2022. Data are from the Centers for Disease Control and Prevention’s WONDER database. WONDER, Wide-Ranging Online Data for Epidemiologic Research.

Figure 2.

Absolute differences in opioid-involved mortality rates in 2022 between American Indian/Alaskan Native and White and between Black and White populations. (A) American Indian/Alaskan Native and White. (B) Black and White populations. Data are from the Centers for Disease Control and Prevention’s WONDER database. States are missing if <20 deaths were reported in any given subgroup, per CDC WONDER reporting guidelines. CDC, Centers for Disease Control and Prevention; WONDER, Wide-Ranging Online Data for Epidemiologic Research.

Figure 3.

Annual age-adjusted and race-stratified opioid-involved mortality with 95% CIs from 1999 to 2022 in which either methamphetamines or cocaine were also involved. (A) methamphetamines. (B) cocaine. Data are from the Centers for Disease Control and Prevention’s WONDER database. WONDER, Wide-Ranging Online Data for Epidemiologic Research.

Figure 4.

Opioid-involved mortality rates with each racial group stratified by Hispanic (lighter shades) and non-Hispanic (darker shades) ethnicity. Deaths are pooled across 2017 to 2022, hence the use of crude (versus age-adjusted) mortality rates. Data are from the Centers for Disease Control and Prevention’s WONDER database. WONDER, Wide-Ranging Online Data for Epidemiologic Research.