Opioid-related overdose mortality in the era of fentanyl: Monitoring a shifting epidemic by person, place, and time

Drug Alcohol Depend. 2020 Nov 1:216:108321. doi: 10.1016/j.drugalcdep.2020.108321. Epub 2020 Sep 25.


Background: With the emergence of illicit fentanyl, fentanyl-involved overdose rates increased from 2013 to 2017 in the United States (US). We describe US trends in opioid-related overdose mortality rates by race, age, urbanicity, and opioid type before and after the emergence of fentanyl.

Methods: Using the Centers for Disease Control and Prevention's WONDER database, we estimated crude and age-standardized opioid-related overdose mortality rates at the intersections of race (non-Hispanic [NH] Black and white), age (<55 and ≥55 years), sex (male and female) and urbanicity (urban and rural residence) from 2005 to 2017. We compare relative changes in mortality from 2013 to 17, and describe changes in the contributions of fentanyl, heroin, and other opioids to opioid-related overdose mortality.

Results: From 2013 to 2017, the overall opioid overdose mortality rate was consistently higher in NH white Americans, however, the rate increase was greater among NH Black (174 %) compared to NH white (85 %) Americans. The steepest increases occurred in the overdose rates between 2013 and 2017 among younger (aged <55 years) urban NH Black Americans (178 % increase). Among older (≥55 years) adults, only urban NH Black Americans had an increase in overdose-related mortality rate (87 % increase). Urban NH Black Americans also experienced the greatest increase in the percent of fentanyl-involved deaths (65 % in younger, 61 % in older).

Conclusions: In the era of increased availability of illicitly manufactured fentanyl (2013-2017), there has been a disproportionate increase in opioid-related overdose deaths among urban NH Black Americans. Interventions for urban NH Black Americans are urgently needed to halt the increase in overdose deaths.

Keywords: Black Americans; Fentanyl; Health inequity; Overdose; Urban.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Analgesics, Opioid / poisoning*
  • Centers for Disease Control and Prevention, U.S. / trends*
  • Databases, Factual / trends*
  • Epidemics / prevention & control
  • Female
  • Fentanyl / poisoning*
  • Heroin / poisoning
  • Humans
  • Male
  • Middle Aged
  • Opiate Overdose / diagnosis*
  • Opiate Overdose / mortality*
  • Time Factors
  • United States / epidemiology
  • Young Adult


  • Analgesics, Opioid
  • Heroin
  • Fentanyl