An examination of Black-White disparities in repeat nonfatal opioid overdose incidents, fatal drug overdose, and all-cause mortality in Detroit, Michigan

Background

There has been an approximately 38 percent increase in overdose deaths for Black men since 2015 yet estimates vary between major metropolitan areas. It is crucial to examine local data to inform community-driven harm reduction and overdose prevention services. We used administrative data to examine the effect of demographic characteristics and repeated nonfatal opioid overdoses (NFOO) on drug-related and all-cause mortality.

Methods

Emergency medical services (EMS) data were linked to vital records to determine fatal drug overdose and all-cause mortality. Demographic measures included age, race (Black/White), and sex (male/female). Binary logistic regression modeling was used to assess the relative influence of each of these factors on the odds of a fatal drug overdose.

Results

Among decedents, 27.0 % (n=47) experienced at least one additional NFOO prior to death. After controlling demographic characteristics, the odds of a fatal drug overdose increased by 17 % for each additional NFOO. Compared to White individuals, Black individuals were 60 % less likely to experience a fatal drug overdose, despite experiencing a significantly greater number of NFOO. All-cause mortality among Black individuals was approximately double that experienced by White individuals following a nonfatal opioid overdose.

Conclusion

There is a high risk of fatal drug overdose in the two-years following a nonfatal opioid overdose, and a greater risk of repeated NFOO. Black individuals’ mortality was associated with non-overdose causes, despite being associated with experiencing a significantly greater number of nonfatal overdoses. Widespread implementation of overdose prevention and general medical care is warranted to curb NFOO and allcause mortality.