Since as early as 2013, synthetic opioids such as illicitly manufactured fentanyl (IMF) have contributed significantly to the growing opioid epidemic. IMF has been found in various drug supplies, including counterfeit prescription pills, raising the rate at which the population is exposed to it. Accordingly, 59% of deaths involving an opioid overdose in 2017 involved some sort of synthetic opioid. A recent study published by the Centers for Disease Control and Prevention analyzed how rates of overdose deaths changed between 2015 and 2017 in people aged 18 years and older.
Researchers used the National Vital Statistics System files to identify overdose deaths caused by acute toxicity from drugs. The types of opioid involved were categorized as any opioid or synthetic opioids, although some cases involved both. The death rates per 100,000 population for the years 2015 through 2017 were examined for various age groups and stratified by race/ethnicity and metropolitan area. Overall, there were sharp increases in synthetic opioid-related deaths across metropolitan areas, with overdose deaths increasing among minority populations who had experienced low opioid-overdose death rates in the past.
Blacks aged 45 to 54 in large central metropolitan areas had the largest absolute increase in opioid overdose death rates from 19.3 to 41.9 per 100,000 for any opioid and from 5.7 to 29.4 per 100,000 for synthetic opioids. Blacks aged 65 and older had the largest overall percentage increase. In large fringe metropolitan areas, whites aged 25 to 34 had the highest rates of opioid overdose deaths, as well as highest absolute increase in rates, from 36.9 to 58.3 per 100,000 for any opioid and 14.6 to 42.5 per 100,000 for synthetic opioids. In medium/small metropolitan areas, whites aged 25 to 34 had the highest rates of opioid-involved drug overdose deaths in 2017, with blacks aged 18 to 24 experiencing the largest percentage increase of 139% from 2015 to 2017. The group with the largest overall percentage increase in these areas were Hispanics aged 25 to 34, with a 379% increase in death rates. By the last year examined in the study, the greatest level of synthetic opioids in opioid-related overdose deaths was among blacks across metropolitan areas, with the majority in large metropolitan areas. Whites had the second highest synthetic opioid death rate overall, and Hispanics had the third.
The researchers contend that this study highlights the shifting demographics of those who are affected by the opioid crisis, particularly with respect to synthetic opioid involvement. The findings point to the increasing diversity of opioid users and risk factors for overdose among age, racial/ethnic, and metropolitan groups. The researchers posit that some of the underlying factors contributing to the results of the study may be attributed to differences in opioid prescribing rates, access to substance use disorder treatment, and the distribution of IMF in illicit drug supplies.
The study was limited by possibly differences in death investigation processes, changes in reporting practices over the course of the study, potential racial/ethnic misclassification, and the exclusion of some groups in the study because of low overall death rates.
Because the demographics of opioid-involved overdose deaths are changing, the researchers suggest that prevention strategies take into account the risk factors associated with various racial/ethnic groups. They also suggested that public messaging surrounding the presence of synthetic opioids be implemented, medication for overdose reversal be made more available, and medication-assisted treatment be more widely offered. These strategies, the researchers continue, will require collaboration across government bodies, law enforcement, public heath offices, and individual communities.
Lippold KM, Jones CM, Olsen EO, Giroir BP. 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. MMWR Morb Mortal Wkly Rep. 2019;68:967-973.