Overview: The overdose epidemic persists in the United States as thousands of Americans continue to lose their lives each year to fatal overdose events. This study investigated racial/ethnic trends in non-fatal and fatal overdoses in Detroit, and we explore whether these disparities changed significantly due to the COVID-19 epidemic.Proposal text:
Background: The overdose epidemic persists in the United States as thousands of Americans continue to lose their lives each year to fatal overdose events. In 2020 alone, there were approximately 93,000 overdose deaths in the US, with the majority of these deaths being opioid related (Centers for Disease Control & Prevention, 2021). Evidence suggests that the overdose epidemic is being exacerbated as part of a syndemic with COVID-19. Indeed, several parts of the country have experienced spikes in overdose deaths since the height of the pandemic (Alter & Yeager, 2020; Appa et al., 2021; Holland et al., 2021; Kuehn, 2021; Ochalek et al., 2020; Slavova et al., 2020). In Philadelphia, current evidence illustrates that Black individuals have been disproportionately impacted by non-fatal and fatal overdoses during COVID-19 (Khatri et al., 2021). In the current study, we sought to confirm the findings in Philadelphia by Khatri et al. (2021) by examining racial/ethnic disparities in non-fatal and fatal overdoses in the pre- and post-COVID-19 periods.
Methods: We referred to Michigan EMS Information System (MI-EMSIS) naloxone administration data, accessed via the University of Michigan’s System for Opioid Overdose Surveillance (SOS) dashboard, as a proxy for nonfatal opioid overdose. Fatal opioid overdose we determined using Medicolegal Death Investigation Log (MDILog) and individual county medical examiner data, also accessed via SOS. Race/ethnicity was categorized in SOS. We identified and compared monthly totals among Whites, Blacks, and Hispanics/Latinos in [city] between periods A (April through June 2019) and C (April through June 2020), and B and C (December 2019 through February 2020) with paired samples t-tests, aligning our analysis with that in Khatri, Pizzicato, Viner, et al (2021) for comparison.
Results: Among neither Blacks nor Whites did we determine a statistically significant difference (a=.05) between frequency of opioid overdose during period A and period C or between frequency of opioid overdose during period B and C. Among Hispanics/Latinos, average fatal overdoses during period A (M=0.33, SD=0.577) were fewer compared to those during period C (M=2.00, SD=0.00); t(5)=-5.00, p=.038; no other periods differed in either fatal or nonfatal overdoses. Table 1 summarizes fatal and nonfatal overdoses within each period by race category. Figures 1 and 2 present Black non-Hispanic, White non-Hispanic, and Hispanic/Latino monthly fatal and nonfatal overdoses from January 2019 through June 2020.
Discussion: Increases in opioid overdoses during COVID-19 have set all-time records yet there is a dearth of knowledge on the differential trends among racial/ethnic groups and even fewer confirmatory studies. Our findings suggest that Black individuals in Detroit had greater rates of non-fatal and fatal overdoses pre- and post-COVID-19. However, the racial/ethnic disparities presented here did not reach statistical significance. Future studies should continue to investigate data on race/ethnicity from other cities should be prioritized while also attending to monitoring long term trends in Philadelphia and Detroit as COVID-19 and overdoses continue to be major threats to public health.
