As Philadelphia faces a deadly pandemic and its effects on the existing opioid crisis, research suggests black residents have been particularly affected by fatal overdoses since the rise of COVID-19.
Fatal overdoses among black residents increased more than 50% in the months following the Pennsylvania stay-at-home order compared to the same period in the previous year. The number of overdose deaths among white residents has decreased significantly over this period.
Penn Medicine researchers analyzed opioid overdose trends published last year by the Philadelphia Department of Public Health and the Philadelphia Fire Department after seeing evidence of an increase in fatalities among black residents. Their findings mark a reversal in the trends generally seen in the opioid epidemic.
“Philadelphia has been devastated by the opioid crisis, which was previously acutely experienced in the white community,” said Dr. Utsha Khatri, an emergency physician and lead author of the study, published in JAMA Network Open. “Recently, however, we have followed a troubling trend toward higher rates of fatal and non-fatal overdoses among residents of Black Philadelphia. These different trends in opioid overdose suggest that racial inequalities were exacerbated by the pandemic.”
The study examined three separate time periods:
• Period A. – April to June 2019
• Period B. – December 2019 to February 2020
• Period C. – April to June 2020
Researchers chose Period C to coincide with the full months after the stay-at-home order, while Period A provided a year-over-year comparison and Period B provided a look at the months leading up to the pandemic.
Overall, fatal overdoses remained relatively unchanged in Philadelphia in a year-over-year comparison between Period A and Period C. The city had an average of 94 overdose deaths per month in Period A and 98 deaths per month in Period C.
But among black individuals, the number of overdose deaths increased from a monthly average of about 30 in Period A and B to about 49 in Period C.
Fatal overdoses among white residents of Philadelphia fell from a monthly average of 46 and 45 in Period A and B, respectively, to just 35 in Period C. That represented a 31% year-over-year decline and a 22% decline from pandemic time frame.
Among Hispanic residents, the average number of fatalities per month decreased from about 16 to 12 from Period A to Period B, but then rose to about 14 in Period C.
Similar racial trends were observed in non-fatal overdoses in Philadelphia.
Source / JAMA Network Open
Penn researchers published their demographic findings on the opioid deaths in Philadelphia in JAMA Network Open.
“The results of this study are sobering, ”said senior author Eugenia South, an assistant professor of emergency medicine at Penn. The black community has been hit incredibly hard since the start of the pandemic – both from the disease itself and from the social and economic fallout, including increased gun violence, job losses and small business closures. We believe the increase in fatal and non-fatal opioid overdoses is a symptom of this. “
The study’s publication comes as the city’s health department grapples with changing causes and demographics of the opioid epidemic.
Preliminary 2020 statistics include a total of 950 deaths from January to September. When all information is recorded and verified, 2020 is expected to be the city’s deadliest year for opioid overdoses.
Much of this is attributed to the continued emergence of the lethal synthetic opioid fentanyl, which is increasingly found alongside heroin in drug mixtures containing methamphetamine, PCP and cocaine. The health department warned this week that “fentanyl is in everything,” with statistics on overdose deaths linked to fentanyl in combination with other drugs in recent years.
The Penn research team believes the growing prevalence of fentanyl may partly explain why fatal overdoses have increased among black residents.
“How this translated into an increase in accidental drug overdoses is not known, but may be related in part to the purchase of more economical drugs from lesser known sources,” said study co-author Kendra Viner, the division’s health division leader in the field of health care. substance use. prevention. “Our concern is that fentanyl, a powerful synthetic opioid that is cheaper to manufacture and distribute, is increasingly found in non-opioid drugs. This may put populations of drug users who have not previously been exposed to opioids at higher risk. on an overdose. “
The researchers also theorized that access to opioid treatment remains unfair. Buprenorphine, a prescription drug used to ease opioid cravings, remains more available to white patients than to black patients.
And while research shows that drug use tends to be fairly similar across racial boundaries, black people are more likely to face legal penalties for it. 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 in opioid overdose deaths in other U.S. cities may become apparent upon closer analysis. The study authors advocate for health departments to publicly report opioid overdoses by race.
“Cities across the country need to investigate trends in overdoses among different sociodemographic groups to gain a more detailed understanding of who is the victim and how best to respond to response,” said Khatri.
The health department is currently developing a community education initiative to raise awareness and prevent overdose with fentanyl drug mixtures. The program includes the distribution of fentanyl test strips 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 wider access to buprenorphine, and provide greater support for so-called “warm transfers” of drug treatment from health care, prison and community.
The Penn study was supported by grants from the U.S. Centers for Disease Control and Prevention and the Robert Wood Johnson Foundation.