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Opioid-related overdose mortality in the era of fentanyl: Monitoring a shifting epidemic by person, place, and time.
Drug Alcohol Depend. 2020 11 01; 216:108321.DA

Abstract

BACKGROUND

With the emergence of illicit fentanyl, fentanyl-involved overdose rates increased from 2013 to 2017 in the United States (US). We describe US trends in opioid-related overdose mortality rates by race, age, urbanicity, and opioid type before and after the emergence of fentanyl.

METHODS

Using the Centers for Disease Control and Prevention's WONDER database, we estimated crude and age-standardized opioid-related overdose mortality rates at the intersections of race (non-Hispanic [NH] Black and white), age (<55 and ≥55 years), sex (male and female) and urbanicity (urban and rural residence) from 2005 to 2017. We compare relative changes in mortality from 2013 to 17, and describe changes in the contributions of fentanyl, heroin, and other opioids to opioid-related overdose mortality.

RESULTS

From 2013 to 2017, the overall opioid overdose mortality rate was consistently higher in NH white Americans, however, the rate increase was greater among NH Black (174 %) compared to NH white (85 %) Americans. The steepest increases occurred in the overdose rates between 2013 and 2017 among younger (aged <55 years) urban NH Black Americans (178 % increase). Among older (≥55 years) adults, only urban NH Black Americans had an increase in overdose-related mortality rate (87 % increase). Urban NH Black Americans also experienced the greatest increase in the percent of fentanyl-involved deaths (65 % in younger, 61 % in older).

CONCLUSIONS

In the era of increased availability of illicitly manufactured fentanyl (2013-2017), there has been a disproportionate increase in opioid-related overdose deaths among urban NH Black Americans. Interventions for urban NH Black Americans are urgently needed to halt the increase in overdose deaths.

Authors+Show Affiliations

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, Maryland, 21205, USA. Electronic address: kalthoff@jhu.edu.Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, Maryland, 21205, USA; Department of Health Policy and Management, UCLA Fielding School of Public Health, 650 Charles E. Young Dr. S., Los Angeles, CA 90095, USA.Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, Maryland, 21205, USA.Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, Maryland, 21205, USA.Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, Maryland, 21205, USA.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

33007700

Citation

Althoff, Keri N., et al. "Opioid-related Overdose Mortality in the Era of Fentanyl: Monitoring a Shifting Epidemic By Person, Place, and Time." Drug and Alcohol Dependence, vol. 216, 2020, p. 108321.
Althoff KN, Leifheit KM, Park JN, et al. Opioid-related overdose mortality in the era of fentanyl: Monitoring a shifting epidemic by person, place, and time. Drug Alcohol Depend. 2020;216:108321.
Althoff, K. N., Leifheit, K. M., Park, J. N., Chandran, A., & Sherman, S. G. (2020). Opioid-related overdose mortality in the era of fentanyl: Monitoring a shifting epidemic by person, place, and time. Drug and Alcohol Dependence, 216, 108321. https://doi.org/10.1016/j.drugalcdep.2020.108321
Althoff KN, et al. Opioid-related Overdose Mortality in the Era of Fentanyl: Monitoring a Shifting Epidemic By Person, Place, and Time. Drug Alcohol Depend. 2020 11 1;216:108321. PubMed PMID: 33007700.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Opioid-related overdose mortality in the era of fentanyl: Monitoring a shifting epidemic by person, place, and time. AU - Althoff,Keri N, AU - Leifheit,Kathryn M, AU - Park,Ju Nyeong, AU - Chandran,Aruna, AU - Sherman,Susan G, Y1 - 2020/09/25/ PY - 2020/01/18/received PY - 2020/09/15/revised PY - 2020/09/17/accepted PY - 2021/11/01/pmc-release PY - 2020/10/3/pubmed PY - 2020/10/3/medline PY - 2020/10/2/entrez KW - Black Americans KW - Fentanyl KW - Health inequity KW - Overdose KW - Urban SP - 108321 EP - 108321 JF - Drug and alcohol dependence JO - Drug Alcohol Depend VL - 216 N2 - BACKGROUND: With the emergence of illicit fentanyl, fentanyl-involved overdose rates increased from 2013 to 2017 in the United States (US). We describe US trends in opioid-related overdose mortality rates by race, age, urbanicity, and opioid type before and after the emergence of fentanyl. METHODS: Using the Centers for Disease Control and Prevention's WONDER database, we estimated crude and age-standardized opioid-related overdose mortality rates at the intersections of race (non-Hispanic [NH] Black and white), age (<55 and ≥55 years), sex (male and female) and urbanicity (urban and rural residence) from 2005 to 2017. We compare relative changes in mortality from 2013 to 17, and describe changes in the contributions of fentanyl, heroin, and other opioids to opioid-related overdose mortality. RESULTS: From 2013 to 2017, the overall opioid overdose mortality rate was consistently higher in NH white Americans, however, the rate increase was greater among NH Black (174 %) compared to NH white (85 %) Americans. The steepest increases occurred in the overdose rates between 2013 and 2017 among younger (aged <55 years) urban NH Black Americans (178 % increase). Among older (≥55 years) adults, only urban NH Black Americans had an increase in overdose-related mortality rate (87 % increase). Urban NH Black Americans also experienced the greatest increase in the percent of fentanyl-involved deaths (65 % in younger, 61 % in older). CONCLUSIONS: In the era of increased availability of illicitly manufactured fentanyl (2013-2017), there has been a disproportionate increase in opioid-related overdose deaths among urban NH Black Americans. Interventions for urban NH Black Americans are urgently needed to halt the increase in overdose deaths. SN - 1879-0046 UR - https://www.unboundmedicine.com/medline/citation/33007700/Opioid_related_overdose_mortality_in_the_era_of_fentanyl:_Monitoring_a_shifting_epidemic_by_person_place_and_time_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0376-8716(20)30486-5 DB - PRIME DP - Unbound Medicine ER -