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Differences in trajectories of fatal and nonfatal opioid overdose by race and ethnicity in the HEALing Communities Study from 2018 to 2023
Goddard-eckrich, D., Chahine, R. A., Chandler, R., Villani, J., Gilbert, L., Salsberry, P. J., Walsh, S. L., Lancaster, K. E., Oga, E., Mack, N. A., D'Costa, L., Chatterjee, A., Walley, A. Y., Kim, E., Calver, K., Huang, T. T. K., Hunt, T., Mack, S., Brown, J. L., ... Feaster, D. J. (2026). Differences in trajectories of fatal and nonfatal opioid overdose by race and ethnicity in the HEALing Communities Study from 2018 to 2023. Journal of Substance Use & Addiction Treatment. https://www.jsatjournal.com/article/S2949-8759(26)00247-X/abstract
Introduction Racial and ethnic differences in opioid overdose outcomes are a significant public health challenge in the United States. Methods We examined differences in trajectories of fatal opioid overdose deaths (OOD) and nonfatal opioid overdoses (NFO) across different racial and ethnic groups and treatment assignment using data from the HEALing Communities Study, a cluster-randomized trial in 67 highly impacted communities in Kentucky, Massachusetts, New York, and Ohio from 2020 to 2023. Rates were calculated as events per 100,000 adults, with trends visualized by treatment assignment. Absolute risk differences and mixed models were used to examine the differences in OOD and NFO trajectories. Results Non-Hispanic Black individuals had greater increases in OOD rates than Hispanic and Non-Hispanic White individuals (F(3,1507) = 3.26, p < 0.021), while NFO rates were higher across time for non-Hispanic Black individuals than for Hispanic and Non-Hispanic White individuals (F(3,195) = 3.12, p < 0.027). Non-significant reductions in both OOD and NFO rates were observed in the intervention group for non-Hispanic Black individuals compared with controls, with relative risk reductions of 24–30% for OOD and 21–27% for NFO in the period of 2021–2022. In stratified analyses, non-Hispanic Black individuals were observed to have 31% and 55% higher rates of OODs than non-Hispanic White individuals in 2021 and 2022, respectively, in intervention communities. This difference, though not statistically significant, was more pronounced in control communities, where non-Hispanic Black individuals experienced 91% and 104% higher rates of OOD than non-Hispanic White individuals. Conclusions and relevance The study intervention reduced, but did not eliminate, Black-White differences in OOD rates. Expansion of culturally tailored interventions, strategies, and policies that address contributors to differences in health care access may help to reduce them further.
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