As stricter prescribing rules make prescription opioids less accessible, those with opioid use disorder are turning to synthetic substances instead. This shift has led to a recent rise in overdose deaths linked to synthetic opioids, like fentanyl. New research from the Center for Health and Justice Research (CHJR) at the Indiana University Public Policy Institute finds a dramatic increase in these deaths in recent years, along with an increasingly high risk of death for African-Americans.

SPEA associate professor Dr. Brad Ray leads the CHJR and in his latest research on opioid deaths, published in the journal Addictive Behaviors, examined fentanyl-related overdose trends in Marion County, Indiana from 2010 through April 2017.

During that time, rates of overdoses involving fentanyl rose significantly. Those rates had remained lower than 15 percent from 2010 through 2013. However, they skyrocketed in recent years. By 2017, nearly half of all overdose deaths involved fentanyl. As time passed, there was also a shift from fentanyl simply being one opioid in the victim’s system to being the only opioid.

One critical finding in this research revealed that the specific risk to African-Americans increased rapidly between 2011 and 2017. Early on in the study, Caucasian residents faced a risk that was three times greater than that of African-Americans. However, those numbers have shifted and jumped drastically. Now, young African-American males make up the majority of victims.

Yet an even deeper look at these findings reveal another troubling trend: African American women face an increasingly high risk of death from fentanyl-related overdoses. In fact, in 2017, African-American females had a 62 percent risk rate of fentanyl-related overdose deaths — the highest of all study groups — compared to a 40 percent rate of risk for Caucasian women.   

Strained relationships between the African-American community and law enforcement, as well as the mass incarceration of people of color for drug-related charges, may play a critical role in the disparities. For example, preliminary research findings from CHJR suggest that among African-Americans who are revived by naloxone only half of the time is the corresponding 911 call for an overdose, while among Caucasians more than 80 percent of the time the call is for an overdose. That means that when African-Americans are experiencing an overdose they are less likely to call and report the event as overdose; instead they often refer to the person as unresponsive.

Ray says these findings should serve as a call to action to develop policies and programs to address the rise in fentanyl-related deaths and the increasing disparities found among victims. One strategy would be to provide drug testing technologies (such as fentanyl strips) to help users avoid ingestion of fentanyl. Leaders should also work to provide culturally-appropriate responses for those at highest risk of fentanyl exposure and death. Quality education programs should help potential fentanyl users better understand how to protect themselves and others from exposure and overdose, saving lives across Marion County.

This study was funded by the Centers for Disease Control and Prevention. The complete study can be found online at this link.

Dr. Brad Ray, a School of Public and Environmental Affairs associate professor, is director of Center for Health and Justice Research (CHJR) at the IU Public Policy Institute. Emily Sightes is a graduate research assistant for CHJR. Leslie Wells is SPEA assistant director of communications.


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