Abstract
Among the 47,600 opioid-involved overdose deaths in the United States in 2017, 59.8% (28,466) involved synthetic opioids (1). Since 2013, synthetic opioids, particularly illicitly manufactured fentanyl (IMF), including fentanyl analogs, have been fueling the U.S. overdose epidemic (1,2). Although initially mixed with heroin, IMF is increasingly being found in supplies of cocaine, methamphetamine, and counterfeit prescription pills, which increases the number of populations at risk for an opioid-involved overdose (3,4). With the proliferation of IMF, opioid-involved overdose deaths have increased among minority populations including non-Hispanic blacks (blacks) and Hispanics, groups that have historically had low opioid-involved overdose death rates (5). In addition, metropolitan areas have experienced sharp increases in drug and opioid-involved overdose deaths since 2013 (6,7). This study analyzed changes in overdose death rates involving any opioid and synthetic opioids among persons aged ≥18 years during 2015-2017, by age and race/ethnicity across metropolitan areas. Nearly all racial/ethnic groups and age groups experienced increases in opioid-involved and synthetic opioid-involved overdose death rates, particularly blacks aged 45-54 years (from 19.3 to 41.9 per 100,000) and 55-64 years (from 21.8 to 42.7) in large central metro areas and non-Hispanic whites (whites) aged 25-34 years (from 36.9 to 58.3) in large fringe metro areas. Comprehensive and culturally tailored interventions are needed to address the rise in drug overdose deaths in all populations, including prevention strategies that address the risk factors for substance use across each racial/ethnic group, public health messaging to increase awareness about synthetic opioids in the drug supply, expansion of naloxone distribution for overdose reversal, and increased access to medication-assisted treatment.
Highlights
Morbidity and Mortality Weekly ReportRacial/Ethnic and Age Group Differences in Opioid and Synthetic Opioid– Involved Overdose Deaths Among Adults Aged ≥18 Years in Metropolitan Areas — United States, 2015–2017
The increased involvement of synthetic opioids in overdose deaths is changing the demographics of the opioid overdose epidemic
Competent interventions are needed to target populations at risk; these interventions include increasing awareness about synthetic opioids in the drug supply and expanding evidence-based interventions, such as naloxone distribution and medication-assisted treatment. Consistent with these findings, a recent report by the New York City Department of Health and Mental Hygiene (8) identified high rates of drug overdoses in 2017 involving heroin or fentanyl among middle-aged and older-aged blacks and Hispanics in a large metropolitan area infiltrated by IMF in recent years; these rates have largely eclipsed those among whites of the same age (9)
Summary
Racial/Ethnic and Age Group Differences in Opioid and Synthetic Opioid– Involved Overdose Deaths Among Adults Aged ≥18 Years in Metropolitan Areas — United States, 2015–2017. Crude death rates per 100,000 population for overdose deaths involving any opioid and those involving synthetic opioids were examined for 2015–2017 by age group stratified by race/ethnicity within metropolitan areas (large central metro, large fringe metro, and medium/small metro). Metropolitan area was based on the 2013 urbanization classification scheme.† Analyses comparing absolute and percentage changes in death rates from 2015 to 2017 used z-tests when deaths were ≥100 and nonoverlapping 95% confidence intervals based on a gamma distribution when deaths were
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