Association between experiences of discrimination and depression/anxiety among racial and ethnic groups

By Lauren DeSouza- Master of Public Health, Simon Fraser Public Research University – Canada
https://empathymh.org/our-team/

Staff Research and Content Writer

© Copyright – Empathy Mental Health – Inc, Milwaukee, Wisconsin – June 2025 – All rights reserved.

Since the onset of the opioid crisis in the late 1990s, nearly 1 million lives have been lost to drug-related overdoses. This ongoing crisis, now spanning three decades, continues to significantly impact the overall life expectancy in the US. Initially, the burden of opioid use and overdose mortality was highest among White populations, with White men constituting 76% of cases in 2016. However, overdose mortality rates have plateaued among White Americans— but they have surged among racialized Americans. As of 2019, disproportionately high overdose rates have been observed among Black and American Indian populations, transforming the opioid crisis into a racial equity crisis alongside a public health crisis.

Drug use and overdose mortality rates are also higher among men than women, especially among men of color. An intersectional approach is needed to understand the overlapping impacts of race, gender, and sex in overdose mortality. Unfortunately, traditional approaches to collecting and categorizing data on drug use make it difficult to appreciate the intersectional impacts of race and gender in this crisis. Data classifies race and sex as separate structures when, in reality, they are inextricably linked.

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A recent study published in JAMA Network Open aimed to deepen our understanding of the intersectional impact of the opioid crisis and its evolution over time. The insights from this study can help identify the sociodemographic groups that are in greatest need of support.

The authors used White men as the reference group against which they measured years of potential life lost (YPLL). White men had the highest YPLL among the 4 categories, but the authors noticed distinct trends when examining the data over time. These trends are outlined in the next section.

How has opioid overdose mortality changed among these race-sex groups over time?

From 2010 to 2020, mortality rates due to unintentional drug poisoning increased across all four race-sex groups: Black men, Black women, White men, and White women. However, the burden of overdose deaths has not increased evenly across these groups.

Among the most striking findings was the shift in overdose mortality rates between Black and White men. In 2016, the mortality rate for Black men surpassed that of White men and continued to rise sharply. By 2020, Black men were experiencing overdose mortality rates nearly 60% higher than White men.

A similar pattern emerged among women. While rates among both Black and White women rose gradually, overdose mortality among Black women surpassed White women in 2019, suggesting a concerning shift in overdose burden among this group as well.

Years of potential life lost (YPLL) remained highest among White men over the study period, likely due to their larger population size. However, temporal trends show that YPLL is worsening among Black men and women—indicating a growing burden of premature death in these groups—while possibly improving for White women.

Kao et al., 2025

To better understand how these shifts were unfolding over time, the authors conducted a temporal analysis comparing two distinct periods: 2010–2015 (Wave 3 of the opioid crisis) and 2016–2020 (Wave 4). The data show that mortality rates among Black men rose dramatically in Wave 4.

When the authors mapped these trends geographically, they found that the burden was not equally distributed across the US. For example, Black men in Maryland experienced a 485.4% increase in unintentional drug poisoning mortality between 2015 and 2020. Other states with notably steep increases included the District of Columbia (360.4%), Virginia (291.1%), Alabama (282.8%), North Carolina (270.9%), and New Jersey (267.5%).

Photo by alyssasieb on Nappy

These findings reflect not just an escalating crisis but one that is becoming increasingly racialized, with Black communities—particularly Black men—bearing a growing share of the harm.

Why is opioid overdose mortality worsening among Black Americans?

The results from this temporal intersectional analysis highlight that Black men and women are experiencing an increasing burden of drug overdose mortality compared with their White counterparts. But why is this?

The opioid crisis has evolved and shifted over time, with an increasingly toxic drug supply resulting from the rise in fentanyl and other synthetic opioids. As the data suggests, mortality rates are worsening for Black men in line with the shift to Wave 4 of the opioid crisis. The authors surmise that the unpredictability of the new drug supply landscape may be disproportionately impacting Black men due to the structural determinants of health. Factors including unstable housing, unemployment, exposure to excessive policing and trauma, and a lack of harm reduction services and medications disproportionately burden Black communities and especially Black men.

The cross-sectional design of this study does not provide enough evidence to understand why opioid overdose mortality has changed across different sociodemographic dimensions. The findings emphasize the need for further research on the effects of opioid mortality among racially marginalized and sexually diverse groups.

How can we use the findings of this study?

This study provides valuable information that state and federal stakeholders can use to target populations most heavily burdened by the opioid overdose crisis. These populations, notably Black men, need support and attention from policymakers, health departments, and other partners to mitigate the increasing trend in mortality rates from opioid overdoses.

Black communities would greatly benefit from increased harm reduction services and evidence-based treatment programs. Currently, these services are lacking in many Black neighborhoods, which likely contributes to the rising mortality rates among Black men and women. It is essential to secure additional state and local funding to implement these programs in those areas.

Moreover, this study reinforces the idea that racial and sexual marginalization exacerbate disparities in drug-related mortality. We cannot effectively address drug use and mortality without also tackling the sociopolitical structures that perpetuate marginalization and place the burden of disease disproportionately on these vulnerable groups.

Key Findings

• Unintentional opioid overdose deaths have increased over the past 10 years across the US.
• Opioid overdose mortality is complex and intertwined with sociopolitical structures that perpetuate racial and sexual marginalization.
• Black people, especially Black men, are facing an increasing and disproportionate burden of overdose-related deaths.
• Overdose mortality is higher in certain states for Black people, notably Maryland, D.C., and Virginia.
• Policymakers and public health can use this information to target support, such as harm reduction sites, to certain states and neighborhoods that are facing increases in opioid overdose deaths.

References

Kao, J. H., Rao, D. R., Bucholz, K. K., Bierut, L. J., & Grucza, R. A. (2024). Trends in opioid overdose mortality by race and sex in the U.S., 1999–2020. JAMA Network Open, 7(6), e2414081. https://doi.org/10.1001/jamanetworkopen.2024.14081

Centers for Disease Control and Prevention. (2024, April 16). Understanding the opioid overdose epidemic. https://www.cdc.gov/overdose-prevention/about/understanding-the-opioid-overdose-epidemic.html

Noguchi, Y. (2024, July 9). The opioid crisis is now driven by meth and cocaine, often laced with fentanyl. NPR. https://www.npr.org/sections/shots-health-news/2024/07/09/nx-s1-5015243/stimulant-users-meth-cocaine-coke-in-overdose-fourth-wave-opioid-epidemic