As Philadelphia disputes a deadly pandemic and its effects on the existing opioid crisis, research suggests that black residents have been especially affected by fatal overdoses since the onset of COVID-19.
Fatal overdoses among black residents increased by more than 50% in the months following the Pennsylvania home stay order compared to the same period last year. Overdose deaths among white residents fell markedly during the period.
Penn Medicine researchers analyzed opioid overdose trends released last year by the Philadelphia Department of Public Health and the Philadelphia Fire Department after seeing signs of an increase in fatalities among Black residents . Their findings mark a reversal of trends generally observed in the opioid epidemic.
“Philadelphia has been devastated by the opioid crisis, which was previously experienced more acutely in the white community,” said Dr. Utsha Khatri, an emergency medicine doctor and lead author of the study, published on JAMA Network Open. “Recently, however, we have tracked a disturbing trend toward higher rates of fatal and non-fatal overdoses among Black Philadelphia residents. These differential trends in opioid overdose suggest that racial inequities were exacerbated by the pandemic.” .
The study examined three different time periods:
• Period A – From April to June 2019
• Period B – December 2019 to February 2020
• Period C – From April to June 2020
The researchers chose period C to coincide with the full months following the home stay order, while period A offered a year-over-year comparison and period B took a look at the months leading up to the pandemic.
Overall, lethal overdoses remained relatively unchanged in Philadelphia in a year-over-year comparison between period A and period C. The city averaged 94 overdose deaths in period A and 98 deaths. per month in period C.
But among black individuals, overdose deaths went from a monthly average of about 30 in periods A and B to about 49 in period C.
Deadly overdoses among white Philadelphia residents decreased from a monthly average of 46 and 45 in periods A and B, respectively, to only 35 in period C. This resulted in a 31% year-over-year and 22% decrease. of the pandemic time period.
Among Hispanic residents, average monthly mortality fell from about 16 to 12 from period A to period B, but then increased to about 14 in period C.
Similar racial trends were detected among non-lethal overdoses in Philadelphia.
Source / Network JAMA open
Penn researchers published their demographic findings on Philadelphia opioid deaths at JAMA Network Open.
“The results of this study are staggering, “said senior author Eugenia South, assistant professor of emergency medicine at Penn.” The black community has been severely affected since the onset of the pandemic, with both the disease itself and the social consequences, which include an increase in armed violence, loss of employment and the closure of small businesses. We believe that the increase in the overdose of deadly and non-lethal opioids is a symptom of this. “
The study’s publication comes as the city’s health department faces changing causes and demographic data from the opioid epidemic.
Preliminary statistics for 2020 include a total of 950 deaths from January to September. When all the information is recorded and verified, 2020 is expected to be the deadliest year in the city for opioid overdose.
Much of this has been attributed to the continued rise in deadly synthetic opioid fentanyl, which is increasingly appearing in drug mixtures with methamphetamine, PCP and cocaine, in addition to heroin. The health department warned this week that “fentanyl is in everything,” providing statistics on fentanyl-related overdose deaths combined with other drugs in recent years.
Penn’s research team believes the growing prevalence of fentanyl may partially explain why lethal overdoses have increased among black residents.
“It is unknown how this translates into an increase in accidental drug overdose, but it may be related, in part, to buying cheaper drugs from less familiar sources,” said study co-author Kendra Viner. leader of the health department’s division on substance use prevention. “Our concern is that fentanyl, a potent synthetic opioid that is cheaper to produce and distribute, is increasingly found in non-opioid drugs. This may cause populations of drug users without prior exposure to opioids to have a higher risk of overdose “.
The researchers also theorized that access to opioid treatment remains inequitable. Buprenorphine, a prescription drug used to calm opioid cravings, remains more available to white patients than black patients.
And while research shows that drug use tends to be quite similar across all racial lines, blacks are more likely to face legal sanctions. The treatment has not been effective enough to reach people already involved in the criminal justice system.
The study was limited to Philadelphia, but researchers believe similar trends to opioid overdose deaths in other U.S. cities can be made evident with a more detailed analysis. The study’s authors advocate that health departments publicly report opioid overdose by race.
“Cities across the country need to examine overdose trends in various socio-demographic groups to have a more granular understanding of who is being affected and how best to direct response efforts,” Khatri said.
The health department is currently developing a community education initiative to raise awareness and prevent overdose of fentanyl blends. The program will include the distribution of test strips of fentanyl and naloxone, the anti-overdose drug used to counteract the effect of opioids.
The city will also expand public training on opioid overdose recognition and naloxone use, advocate for wider access to buprenorphine, and provide more support for so-called “warm transfers” to drug treatment from health, prison, and community.
The Penn study received support from grants from the U.S. Centers for Disease Control and Prevention and the Robert Wood Johnson Foundation.