As Philadelphia faces a deadly pandemic and its effects on the existing opioid crisis, the research suggests that black residents have been particularly affected by fatal overdoses since the emergence of COVID-19.
Fatal overdoses among black residents increased by more than 50% in the months following their application to stay in Pennsylvania, compared to the same period a year earlier. Overdose deaths among white residents fell sharply during the period.
Penn Medicine researchers analyzed trends in opioid overdose published last year by the Philadelphia Department of Public Health and the Philadelphia Fire Department, after seeing indications of an increase in deaths among black residents. Their findings mark a reversal of the trends generally seen in the opioid epidemic.
“Philadelphia was devastated by the opioid crisis, which was previously experienced most acutely in the white community,” said Dr. Utsha Khatri, an emergency physician and lead author of the study, published in the JAMA Network Open. “Recently, however, we have been tracking a worrying trend of higher rates of fatal and non-fatal overdoses among Black Philadelphia residents. These differential trends in opioid overdose suggest that racial inequalities have been exacerbated by the pandemic.”
The study looked at three separate time periods:
• Period A – April to June 2019
• Period B – From December 2019 to February 2020
• Period C – April to June 2020
The researchers chose period C to coincide with the full months after the order to stay home, while period A offered a year-over-year comparison and period B provided a view of the months leading up to the pandemic.
Overall, fatal overdoses remained relatively unchanged in Philadelphia in a year-on-year comparison between Period A and Period C. The city averaged 94 overdose deaths per month in Period A and 98 deaths per month in Period C.
But among black individuals, overdose deaths increased from a monthly average of around 30 in periods A and B to approximately 49 in period C.
Fatal overdoses among white Philadelphia residents decreased from a monthly average of 46 and 45 in periods A and B, respectively, to just 35 in period C. This marked a decrease of 31% year on year and a decline of 22% compared to the previous year. previous period pandemic period.
Among Hispanic residents, the monthly average of deaths dropped from around 16 to 12 from period A to period B, but then increased to around 14 in period C.
Similar racial trends have been detected among non-fatal overdoses in Philadelphia.
Open JAMA Source / Network
Penn researchers published their demographic findings about Philadelphia opioid deaths in the JAMA Network Open.
“The results of this study are worrying, “said senior author Eugenia South, assistant professor of emergency medicine at the University of Pennsylvania.” The black community has been hit incredibly hard since the beginning of the pandemic – both with the disease itself and with social and economic aspects, radioactive fallout, which includes increased armed violence, job loss and small business closures. We believe that the increase in fatal and non-fatal opioid overdoses is a symptom of this. “
The study is launched at a time when the city’s health department is fighting changes in the causes and demographics of the opioid epidemic.
Preliminary statistics for 2020 include a total of 950 deaths from January to September. When all information is recorded and verified, 2020 is expected to be the deadliest year in the city for opioid overdoses.
Much of this has been attributed to the continued increase in the deadly synthetic opioid fentanyl, which is increasingly appearing in drug mixes with methamphetamine, PCP and cocaine, in addition to heroin. The health department warned this week that “fentanyl is in everything”, providing statistics on overdose deaths related to fentanyl combined with other drugs in recent years.
The Penn research team believes that the increasing prevalence of fentanyl may partially explain why fatal overdoses have increased among black residents.
“It is not known how this translates into an increase in accidental drug overdoses, but it may be related, in part, to the purchase of more economical drugs from less known sources,” said study co-author Kendra Viner, leader of the use division. substances from the health prevention department. “Our concern is that fentanyl, a potent synthetic opioid that is cheaper to produce and distribute, is increasingly being found in non-opioid drugs. This can put populations of drug users without previous exposure to opioids at a higher risk of overdose. ”
The researchers also theorized that access to treatment with opioids remains uneven. Buprenorphine, a prescription drug used to calm opioid cravings, remains more available to white patients than to black patients.
And while research shows that drug use tends to be quite similar across racial lines, blacks are more likely to face legal penalties for doing so. The treatment has not been effective enough to reach people who are already involved in the criminal justice system.
The study was limited to Philadelphia, but the researchers believe that similar trends in opioid overdose deaths in other cities in the United States may become evident with a more detailed analysis. The study authors argue that health departments publicly report opioid overdoses by race.
“Cities across the country should examine trends in overdoses in various sociodemographic groups to gain a more granular understanding of who is being affected and the best way to target response efforts,” said Khatri.
The health department is currently developing a community education initiative to spread awareness and prevent overdoses involving fentanyl mixtures. 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 the recognition of opioid overdose and the use of naloxone, advocate for broader access to buprenorphine, and provide more support for so-called “hot transfers” for drug treatment in health settings, prison and community.
Penn’s study was funded by grants from the United States Centers for Disease Control and Prevention and the Robert Wood Johnson Foundation.