Abstract
The opioid epidemic has resulted in a threefold increase in drug overdose deaths in the United States during 1999−2015 (1). Whereas American Indians/Alaska Natives (AI/AN) have experienced larger increases in drug overdose mortality than have other racial/ethnic groups in the United States (2), little is known about the regional impact of opioids in tribal and urban AI/AN communities. To address this data gap, death records from the Washington State Center for Health Statistics, corrected for misclassification of AI/AN race, were examined to identify trends and disparities in drug, opioid-involved, and heroin-involved overdose mortality rates for AI/AN and non-Hispanic whites (whites) in Washington. Although AI/AN and whites had similar overdose mortality rates during 1999–2001, subsequent overdose rates among AI/AN increased at a faster rate than did those among whites. During 2013–2015, mortality rates among AI/AN were 2.7 and 4.1 times higher than rates among whites for total drug and opioid-involved overdoses and heroin-involved overdoses, respectively. Washington death certificates that were not corrected for misclassification of AI/AN race underestimated drug overdose mortality rates among AI/AN by approximately 40%. National statistics on the opioid epidemic, which report that overdose mortality rates are significantly higher among whites than among AI/AN, are not reflective of regional prevalences, disparities, and trends. Comprehensive efforts to address the opioid epidemic in AI/AN communities rely on strong partnerships between tribal governments and local, state, and federal entities. Additional measures are needed for community-based surveillance, treatment, and prevention to effectively respond to the epidemic across diverse tribal and urban AI/AN communities.
Highlights
Probabilistic linkages to correct misclassified race can improve accuracy of data on drug overdose mortality for AI/AN in Washington, which is important for state and federal resource allocation and program direction
Additional efforts are needed for community-based substance-use disorder surveillance, treatment, and prevention in AI/AN communities
Some heroin-involved deaths might have been misreported as morphine-involved deaths because of the similarity in metabolism of these two substances (1). This analysis of linkage-corrected death certificates was restricted to one state, which limits the generalizability of findings to AI/AN in other states
Summary
Opioid-Involved, and Heroin-Involved Overdose Deaths Among American Indians and Alaska Natives — Washington, 1999–2015. Whereas American Indians/Alaska Natives (AI/AN) have experienced larger increases in drug overdose mortality than have other racial/ethnic groups in the United States (2), little is known about the regional impact of opioids in tribal and urban AI/AN communities To address this data gap, death records from the Washington State Center for Health Statistics, corrected for misclassification of AI/AN race, were examined to identify trends and disparities in drug, opioid-involved, and heroin-involved overdose mortality rates for AI/AN and nonHispanic whites (whites) in Washington. During 1999–2001, based on death certificates corrected for AI/AN misclassification, AI/AN and whites in Washington had similar age-adjusted total drug, opioid-involved, and heroininvolved overdose mortality rates (Figure). Age-adjusted death rates*,† for total drug,§ opioid-involved, and heroin-involved overdose deaths among American Indians/Alaska Natives and non-Hispanic whites — Washington, 1999–2015
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