(104) The New and Dynamic Nature of the Opioid Epidemic

Abstract Body

Introduction:

There has been a long-standing narrative regarding the opioid epidemic that is no longer accurate. The existing narrative has been perpetuated recently by high profile and large settlements with prescription opioid manufacturers and distributors. These settlements are the results of years of litigation that, when initiated, was an accurate description of the crisis. What was once seen as a white, working-class addiction epidemic that was the result of prescription misuse has been supplanted by an emergency that now disproportionately affects communities of color and is driven by illicit opioids, with synthetic fentanyl, 80-100x more powerful than morphine, displacing prescription and heroin overdoses as the leading killer. Increasingly, street dealers are using cheap fentanyl powder to cut drugs such as cocaine, leading to deadly combinations for unsuspecting buyers. With a 29.4% increase in overdose deaths nationwide in 2020, the narrative surrounding such a dramatic increase needs to be reexamined.

Methods:

We analyzed Medical Examiner and Health Department data in Florida from 2015-2021 to determine how trends in drug overdose deaths have changed during the rise of fentanyl. Summaries of reports, raw Medical Examiner data that we coded to separate overdoses from non-overdose deaths, toxicology reports, and real time Health Department data were analyzed in longitudinal fashion to identify changing trends in overdose deaths.

Results:

For the first time in Florida history, fentanyl was both the top drug in fatal overdoses and cooccurrences in overdoses, up 73% and 70% respectively. Fentanyl passed alcohol and Xanax in 2020 in occurrences and deaths compared to 2019. Early 2020 demographic data of overdoses showed a 51% increase in overdoses in Florida in the first 3 months of the COVID-19 pandemic but a 67% increase in overdose deaths in Hispanics and a 110% in Blacks. In Duval County, Florida, Black overdoses increased from 15 in 2015 to 66 in 2020, a 340% increase that far outpaced the 280% overall increase in the same area and time frame. In Miami-Dade, one of the most diverse counties in Florida, preliminary 2021 data shows the number of Black deaths due to cocaine and/or fentanyl increased by 26.5% compared to a 11.7% increase for whites from 2020. Blacks also take a larger share of combined cocaine/fentanyl deaths with an increase of 12.9% versus a 55.6% decrease in share for whites during the same time period.

Conclusions:

The public and media narratives around the opioid epidemic are outdated and need to be updated to reflect the newest data. Despite the large settlements recently reported widely in the media with drug manufacturers and distributors, the surge in overdoses is driven by illicitly obtained fentanyl and its powerful analogs. This represents a departure from the longstanding story of pharmaceutical companies “dumping” pills into communities. The communities being affected are less likely to have access to prescription medications and more likely to be using illicit drugs that are increasingly contaminated with fentanyl. Adjusting to the changing nature of the epidemic is essential in designing mitigation strategies to combat record overdoses.

References:

O’Donnell, J. K., Halpin, J., Mattson, C. L., Goldberger, B. A., & Gladden, R. M. (2017). Deaths involving FENTANYL, Fentanyl analogs, and U-47700 — 10 STATES, July–December 2016. MMWR. Morbidity and Mortality Weekly Report, 66(43), 1197–1202. https://doi.org/10.15585/mmwr.mm6643e1

LaRue, L., Twillman, R. K., Dawson, E., Whitley, P., Frasco, M. A., Huskey, A., & Guevara, M. G. (2019). Rate of fentanyl positivity among urine drug test results positive for cocaine or methamphetamine. JAMA Network Open, 2(4). https://doi.org/10.1001/jamanetworkopen.2019.2851

Lippold, K. M., Jones, C. M., Olsen, E. O. M., & Giroir, B. P. (2019). 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. Morbidity and Mortality Weekly Report, 68(43), 967–973. https://doi.org/10.15585/mmwr.mm6843a3

Diversity, Equity, and Inclusion: Our data shows that overdoses among the Black community are increasing disproportionately compared to white overdose deaths across the state of Florida. This is increasingly clear in the amount of fentanyl and cocaine overdoses and combinations of fentanyl and cocaine. Without data analysis revealing the racial disparities and the difference in overdoses between different racial groups, mitigation strategies cannot be appropriately created. Blacks who suffer from a SUD are less likely to receive care than whites with the same diagnosis. Increasing access to care for all communities suffering from a population specific diagnosis will decrease racial disparities in care as well as increase the quality of care delivered by treating the root of the problem in each community.