Rising Racial Disparities in Opioid Mortality and Undertreatment of Opioid Use Disorder and Mental Health Comorbidities in Virginia

• Type of Material: Article
• Authors: Jacqueline B Britz, Virginia Commonwealth University; O'Loughlin O'Loughlin, Virginia Commonwealth University; Tracey Henry, Emory University; Alicia Richards, Virginia Commonwealth University; Roy T Sabo, Virginia Commonwealth University
• Language: English
• Date: 2023-04-27
• Publisher: Elsevier
• Publication Version: Final Published Version
• Copyright Statement: © 2023 The Authors
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): https://doi.org/10.1016/j.focus.2023.100102
• Title of Journal or Parent Work: AJMP Focus
• Volume: 2
• Issue: 3
• Start Page: 100102
• Grant/Funding Information: This study was funded by a Department of Medical Assistance Services Support Act Grant.
• Keywords: Health equity; mental health; racial disparities; opioid use disorder; population Health; opioid mortality
• Research Categories: Health Sciences, Mental Health; Health Sciences, Public Health; Sociology, Ethnic and Racial Studies; Anthropology, Medical and Forensic

Abstract

Highlights •There are widening racial disparities in opioid mortality. •Black males were 1.5 times more likely to die of opioid overdose than White males. •Untreated mental health disorders are a risk factor for opioid mortality. •Early treatment of mental health disorders and opioid use disorder is critical to prevent deaths. •Comprehensive socioecologic data can identify the precursors to fatal overdoses. Introduction There were more than 100,000 fatal drug overdoses in the U.S. in 2021 alone. In recent years, there has been a shift in opioid mortality from predominantly White rural communities to Black urban communities. This study aimed to identify the Virginia communities disproportionately affected by the overdose crisis and to better understand the systemic factors contributing to disparities in opioid mortality. Methods Using the state all-payer claims database, state mortality records, and census data, we created a multivariate model to examine the community-level factors contributing to racial disparities in opioid mortality. We used generalized linear mixed models to examine the associations between socioecologic factors and fatal opioid overdoses, opioid use disorder diagnoses, opioid-related emergency department visits, and mental health diagnoses. Results Between 2015 and 2020, racial disparities in mortality widened. In 2020, Black males were 1.5 times more likely to die of an opioid overdose than White males (47.3 vs 31.6 per 100,000; p<0.001). The rate of mental health disorders strongly correlated with mortality (β=0.53, p<0.001). Black individuals are not more likely to be diagnosed with opioid use disorder (β=0.01, p=0.002) or with mental health disorders (β= −0.12, p<0.001), despite higher fatal opioid overdoses. Conclusions There are widening racial disparities in opioid mortality. Untreated mental health disorders are a major risk factor for opioid mortality. Findings show pathways to address inequities, including early linkage to care for mental health and opioid use disorders. This analysis shows the use of comprehensive socioecologic data to identify the precursors to fatal overdoses, which could allow earlier intervention and reallocation of resources in high-risk communities.