Racial and ethnic differences and COVID-19 pandemic-related changes in drug overdose deaths in North Carolina

In 2021, there were ≥100,000 drug overdose deaths in the United States, representing a 50% increase from 2019.1 The onset of the COVID-19 pandemic in 2020 was associated with disruptions in healthcare access,2 increased social isolation and economic uncertainty,3 and changes in the illicit drug supply,4 all of which may have increased the risk of fatal overdose. Notably, the COVID-19 pandemic has disproportionately impacted Black, Hispanic, and American Indian/Alaska Native (AI/AN) communities, exacerbating longstanding inequities in health, social, and economic wellbeing.5 Prior research shows rapid increases in overdose deaths among Black, Hispanic, and AI/AN individuals during the early months of the pandemic.6, 7 However, little is known about the context surrounding overdose deaths among different racial/ethnic groups during the pandemic. The aims of this study were to examine racial/ethnic differences and pandemic-related changes in drug overdose deaths in North Carolina, with an emphasis on the specific drugs involved, bystander presence, and naloxone administration to inform overdose prevention efforts. Given variation in the overdose crisis and programmatic and policy responses across states, we focused on one state, North Carolina. Additional details on trends in overdose deaths in prior years in North Carolina are published elsewhere.8, 9

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