(30) Triangulating Substance Use, Treatment, and Mortality Trends Using Multiple Sources

Introduction: Overdose deaths in the United States continue to rise, driven by an increasingly complex pattern of substance use including opioids, methamphetamine, cocaine, and alcohol. Multi-dimensional data that triangulate substance use, treatment, and mortality trends across racial and ethnic groups can inform equitable prevention and treatment strategies. To provide a comprehensive assessment of the substance use crisis in the United States by reporting 10 years of trends in substance use, treatment, and overdose mortality. We focus on heroin, methamphetamine, cocaine, and alcohol and illuminate racial and ethnic differences across substance-related outcomes.

Methods: Longitudinal, cross-sectional analysis using 2010-2019 data from the National Survey on Drug Use and Health (NSDUH), Treatment Episode Dataset-Admissions (TEDS-A), and CDC’s WONDER Multiple Cause of Death. Among adults aged 18 and over, in the United States, we measured rates of substance use, treatment admissions, and overdose deaths for heroin, methamphetamine, cocaine, and alcohol. Alcohol-involved deaths included both acute and chronic conditions.

Results: Between 2010-2019, heroin, methamphetamine, and cocaine use increased, and alcohol use decreased, though not all changes were statistically significant. Treatment admissions indicating heroin and methamphetamine increased while admissions indicating alcohol or cocaine decreased. Overdose deaths increased among all racial and ethnic groups. The largest proportional increase was in methamphetamine involved deaths (315%-1,228%), followed by heroin (261%-542%), cocaine (90%-322%), and alcohol (30%-63%). Changes in rates of use, treatment, and death for specific substances varied by racial and ethnic group. Heroin treatment admissions increased more among White individuals than Black individuals (67% vs. 27%), while heroin-involved deaths increased more among Black individuals than White individuals (542% vs 315%).

Conclusions: Substance use, treatment, and overdose mortality changed considerably, though not always equivalently, between 2010 and 2019. There were substantial differences in substance-related measures across racial and ethnic groups. Triangulation of substance use trends across data sources may provide opportunities to ensure treatment capacity changes in parallel with shifting substance use patterns.

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