Much of the attention surrounding the nationwide overdose crisis has focused on the substantial increase in overdose deaths among white men, and has more recently been extended to Black men and Native American individuals. However the impact of the opioid epidemic on Black women has not been widely studied or discussed, limiting the development of policy or program initiatives. LDI Senior Fellows Rebecca Arden Harris and David Mandell address this gap in research by measuring years of life lost in Black women, and recent changes that have occurred during the current overdose crisis.

To learn more about the study, we asked Drs. Harris and Mandell a series of questions below.

What motivated you to conduct this research on drug overdose among Black women specifically?

Mandell: Black women often don’t receive the same attention on health concerns as other demographic groups, especially white people and men. Much of the conversation around drug overdoses spotlights the groups with the highest fatality rates, which are usually men. We presented overdose patterns among Black women without comparing them to another group, to ensure the focus remained undivided on their particular circumstances. 

Why have preventable overdose deaths among Black women nearly tripled from 2015 to 2021?

Harris: Overdose rates have skyrocketed among Black women since 2015. The introduction of fentanyl to the drug supply was one driver, and COVID-19 was another, beginning with the first wave in spring 2020. But it’s possible that these are “accelerants,” and not the main source of current demand. Several theories have been proposed to explain the rise in overdose deaths, but actual evidence is thin. We need much more research to get a clearer understanding the social forces and underlying dynamics involved. 

Why has some of the burden shifted from older to younger women

Mandell: The increase of fentanyl in illegal drugs and the rise in fentanyl-involved deaths could mean that younger women are now using more dangerous drugs or have less access to social and material supports that act as a buffer against overdoses.   

How does the years of life lost (YLL) metric differ from other measures for assessing the impact of drug overdose in communities? What does it tell us?

Harris: It’s useful to compare YLL with two other metrics: mortality rates and adult life expectancy. 

Ordinary mortality rates (deaths per 100,000 population) are important for monitoring changes in mortality but do not express the magnitude of harm that premature deaths represent. Life expectancy (the average number of years of life remaining at a given age) is a good summary measure of the current risk of mortality in a population. Because it is an average, however, it doesn’t tell you anything about premature mortality. In contrast, YLL gives more weight to deaths that occur at a younger age. It’s an intuitive measure that draws attention to the extent of life cut short, providing a more poignant perspective on a community’s loss. 

All three metrics are related: mortality rates are needed to calculate life expectancy, and life expectancies are needed to calculate YLL. All three capture meaningful aspects of mortality and provide direct evidence of the wellbeing of a group in society. Steep increases in premature deaths among young people from drugs or other self-inflicted causes are both profoundly tragic and reflect social and political structures that have become unresponsive to the welfare of its citizens. 

How do you see the results of your study informing public health policies and interventions to address the opioid crisis and its impact on marginalized communities?

Harris: Our study was published as a research letter, which meant it was necessarily brief and we couldn’t go into a lot of detail. We hope, however, that this information adds an important perspective to the ongoing discussions about the opioid crisis. We want to give voice to the need for equitable solutions to the opioid crisis that help all people, including Black women–a group often neglected in research. 

Were there any specific challenges or limitations you encountered while conducting this research, and how did you address them? 

Mandell: In this study, we used publicly available data from the Centers for Disease Control and Prevention (CDC), which are pretty accurate for the variables we examined. It was more of a challenge, even in a short research letter, to set the focus of the discussion section when the task is telling someone else’s story. Authors are expected to flesh out the implications of the findings, but at the same time we have to recognize that in population-level studies, we seldom have firsthand knowledge of the circumstances of people whose lives may be very different from our own.  

What future research do you believe should build upon this work to further understand and combat the opioid crisis among Black women and other populations? 

Harris: Studies of the drug crisis are sometimes a little myopic in their focus. In their book “Deaths of Despair and the Future of Capitalism” and in related papers, economists Anne Case and Angus Deaton perform a great service by placing overdose deaths in the wider context of community health and wellbeing. In line with this approach, we’ve noticed that while overdose deaths of Black women have been sharply increasing, there’s also been a significant increase in suicides that emerged with the onset of the COVID-19 pandemic. Further, the percentage of suicides by firearms is increasing, which suggests the intersection of mental health issues, easy access to guns, and socio-economic stressors. Future research must integrate these separate threads to develop a holistic understanding of the public health crises affecting Black women in America. They’re connected parts of a bigger problem in society. Understanding how they fit together is key to finding solutions that are fair and really work, helping us move toward a healthier and more just community for everyone. 

---

The study, “Years of Life Lost to Drug Overdose Among Black Female Individuals in the US, 2015-2021,” was published in December 2022 in JAMA Psychiatry. Authors include Rebecca Arden Harris and David S. Mandell.

---

Author

---