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Overdose deaths across the country decreased by more than 12 percent between May 2023 and May 2024, according to new federal data, a major development in the nation’s efforts to combat the effects of fentanyl. The decrease continued a trend observed in recent months, and was the largest on record, the White House said last week.
But a new analysis from Georgetown University researchers tells a more complicated story about a health crisis still claiming about 100,000 lives every year. In 22 states that track drug overdoses by race and ethnicity, the number of fatal overdoses among Black Americans typically increased between 2022 and 2023, while deadly overdoses among white Americans often decreased, the researchers found.
The findings reveal a continuation of what federal and state health officials have described as a two-track epidemic, with white Americans experiencing better outcomes and Black Americans struggling to keep up. As overdose deaths rose to record levels in recent years, rates among Black and Native Americans were higher. But the more recent data goes further in showing how sharply the experiences of drug users have diverged by race.
In Arizona, for instance, fatal drug overdoses among white people decreased by more than 2 percent, while overdoses among Black people increased by roughly a third. In Michigan, deadly drug overdoses among white people decreased by 12 percent, and increased among Black people by 6 percent. In Maine, fatal overdoses dropped by about 20 percent among white people but rose by over 40 percent among Black people.
In states where decreases were found in both groups, they were typically smaller for Black Americans. In states where increases were found in both groups, they were often greater for Black people. And in places that tracked overdoses among Native and Hispanic Americans, similar disparities arose.
Drug policy experts said that the new data underscored how public health strategies for drug addiction were still being applied unevenly, with deadly consequences. Naloxone, the overdose-reversing medication, has been harder to find for some Black Americans, as have addiction treatments.
“The question becomes: What are we doing wrong?” said Jennifer Martinez, a researcher at the O’Neill Institute for National and Global Health Law at Georgetown University who analyzed the findings, which were collected from public data and public records requests. “Why aren’t we designing policies that are targeting the populations that need it the most? Something is working, but it’s not working for the people that need it most.”
Researchers and federal and state health officials pointed to three trends that helped explain the disparities.
Unequal access to treatment.
Drug policy experts said that the state-level findings were in part predictable. White and Black Americans have long had varying access to addiction treatments and drug tools that allow them to use substances safely.
“We know that Black and white people don’t use drugs at different rates,” said Emily Keller, who oversees opioid response efforts in Maryland. “This feels clearly like a deeper inequity in our society.”
Dr. Elizabeth Salisbury-Afshar, an addiction expert at the University of Wisconsin, pointed to data showing that methadone, a tightly controlled treatment that often requires daily visits to specialized clinics, has typically been more available in urban minority communities. The treatment is difficult to get for rural minority communities, including Native Americans who live on reservations.
Another effective treatment, buprenorphine, can be picked up in a pharmacy and used at home and has been more available to white Americans, Dr. Salisbury-Afshar noted.
Drug overdose deaths among older Black men have been particularly acute, said Tracie Gardner, a former top health official in New York who now leads the Black Harm Reduction Network.
“The addiction field, public health, were not paying attention to older people who had survived the earlier heroin epidemic and were in recovery, or had always continued to use heroin safely,” she said. “And once fentanyl got into the supply of things people were already using, that’s what killed them.”
Methadone, she said, was introduced to prevent recidivism, and is still not perceived by some drug users as a worthwhile or dignified medical resource.
“Black people are not open to embracing methadone because it’s been villainized,” Ms. Gardner added. “Who wants to be known as on methadone?”
A bipartisan group of lawmakers in the House and Senate have worked to advance legislation that would allow methadone to be prescribed by addiction physicians and dispensed at pharmacies, but they have been stymied in part by an intense lobbying effort.
“I’m very optimistic by the end of the year that we will find the vehicle that we can use in order to get it passed,” Senator Edward J. Markey, a Massachusetts Democrat and sponsor of the Senate legislation, said in a recent interview.
Naloxone isn’t always getting to the right people.
Health policy experts have been reluctant to attribute the national drop in drug overdoses to any specific cause. But one factor was likely large federal grants that saturated communities with naloxone during the pandemic.
Minority communities have not benefited consistently from efforts to allocate the medication. In North Carolina last year, free naloxone was distributed more frequently in areas with white people than those with Black people, according to Delesha Carpenter, a health policy researcher at the University of North Carolina who is conducting federally funded research into naloxone availability.
Just over half of ZIP codes where Hispanic and Native Americans live had free naloxone distributed frequently, Dr. Carpenter has found.
Rachel Winograd, an addiction expert at the University of Missouri, St. Louis who helps oversee naloxone distribution in Missouri, said overdose deaths among Black men in the state fell in 2023 for the first time in many years. That could have resulted from state officials responding to data on racial disparities among overdose victims during the pandemic, she said. The state steered federal grants and opioid settlement funds to community groups in the northern part of the city, creating “depots” of naloxone, Dr. Winograd added.
“People are more likely to use together in a dense urban center, giving them a better chance to save lives,” she said of the efforts to get naloxone to the right people. “It requires infrastructure and concerted effort to reach these groups.”
Data collection on overdoses takes time.
Researchers have long been hindered by the time it takes state laboratories to confirm overdose deaths. The lag often complicates efforts to reach communities with drug users who have been particularly affected by the spread of fentanyl, stimulants or the increasingly prevalent sedative xylazine.
“It’s a resource issue,” said Robert Anderson, who oversees mortality statistics at the National Center for Health Statistics. “We’re all used to watching ‘CSI’ or ‘NCIS,’ where toxicology is ready in 15 minutes. But that’s not typically the way it works.”
Mr. Anderson said that many state laboratories handling toxicology reports were overwhelmed by death reports, creating monthslong backlogs. “That doesn’t count time needed to do an autopsy and death scene investigation, which, depending on resources, can also take time,” he said.
That leaves local health workers behind in responding to drug overdose patterns in minority communities. Native Americans, hit disproportionately by overdose deaths in recent years, have been particularly hurt by this phenomenon, said Philomena Kebec, a member of the Bad River Tribe in Wisconsin.
Native Americans are often misidentified as other races, or not counted in overdose data at all, she said. Roughly 10 of the states Georgetown researchers gathered data from included Black fatality rates but not Native American fatality rates.
Ms. Kebec, who helps oversee the state’s mail-order naloxone program, said that her tribe does not have access to county-level breakdowns of overdoses by race, a concern she has raised with state officials.
“The purpose is to interrupt trends of fatalities for Native Americans and people in rural areas,” she said. “In order to be able to evaluate the effectiveness, we need the racial breakdown of the mortality rates. We’re really running blind.”
Ms. Keller said that Maryland had developed a more sophisticated data collection system that tracks overdoses by ZIP code, allowing groups that help drug users to tailor their outreach.
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