National trends in drug overdose mortality in Asian American, Native Hawaiian, and Pacific Islander populations, 2018-2022

ABSTRACT Background Drug overdose deaths have surged over the past two decades, disproportionately impacting racial/ethnic minority populations. Yet, little is known about drug overdose patterns among Asian American and Native Hawaiian/Pacific Islander (AANHPI) populations. Methods We obtained data on drug overdose deaths and population totals from the CDC WONDER Multiple Cause of Death database and American Community Survey between 2018 and 2022. We calculated crude mortality rates per 100,000, stratified by sex, US Census Division, and drug types: prescription opioids, heroin, fentanyl, cocaine, methamphetamine, and benzodiazepines. Additionally, we conducted disaggregated analyses for six Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese) and three NHPI subgroups (Hawaiian, Guamanian, Samoan). Results In 2022, there were 1226 drug overdose deaths among Asian Americans and 154 among NHPI individuals. The crude mortality rate for NHPI individuals (17.52 per 100,000; 95% CI: 14.76-20.29) tripled that of Asian Americans (5.85 per 100,000; 95% CI: 5.52-6.18). Fentanyl was the leading cause of overdose deaths among Asian Americans (3.17 per 100,000; 95% CI: 2.93-3.41), whereas methamphetamine was predominant among NHPI individuals (11.38 per 100,000; 95% CI: 9.15-13.61). Among Asian American subgroups, Japanese Americans had the highest mortality rate (9.90 per 100,000; 95% CI: 9.61-10.2), and among NHPI subgroups, Guamanians had the highest rates (43.16 per 100,000; 95% CI: 39.05-48.24). Conclusions These findings underscore the urgent need for culturally competent harm reduction services, mental health and addiction treatment, and social services, addressing structural barriers that perpetuate drug overdose disparities in AANHPI communities. Keywords Drug Overdose; Asian American; Native Hawaiian; Pacific Islander; Disaggregated; Racial Disparities