Trends in Fatal Opioid-Related Overdose in American Indian and Alaska Native Communities, 1999–2021

Abstract

IntroductionOpioid-related overdose (OOD) mortality rates have increased sharply in the U.S. over the past two decades, and inequities across racial and ethnic groups have been documented. OOD trends among American Indian/Alaska Native (AI/AN) require further quantification and assessment. MethodsObservational, U.S. population-based registry data on OOD mortality between 1999-2021 were extracted in 2023 using ICD-10 codes from the CDC WONDER multiple cause of death file by race, Hispanic ethnicity, sex, and age. Segmented time series analyses were conducted to estimate OOD mortality growth rates among AI/AN population between 1999-2021. Analyses were performed in 2023. ResultsTwo distinct time segments revealed significantly different OOD mortality growth rates within the overall AI/AN population, from 0.36 per 100,000 (95% CI: 0.32, 0.41) between 1999 and 2019, to 6.5 (5.7, 7.31) between 2019-2021, with the most pronounced increase among those of 24 to 44 years old. Similar patterns were observed within the AI/AN population with Hispanic ethnicity, but the estimated growth rates were generally steeper across most age groups compared to the overall AI/AN population. Patterns of OOD mortality growth rates were similar between AI/AN females and males between 2019-2021. ConclusionsSharp increases in OOD mortality rates among AI/AN communities are evident by age and Hispanic ethnicity, highlighting the need for culturally-sensitive fatal OOD prevention, opioid use disorder treatment, and harm reduction efforts. Future research should aim to understand the underlying factors contributing to these high mortality rates and employ interventions that leverage the strengths of AI/AN culture, including the strong sense of community.