Top 5 Takeaways

  1. Disproportionate Increases Among Black and AI/AN Persons: From 2019 to 2020, overdose death rates soared by 44% for Black individuals and by 39% for AI/AN individuals, compared to a 22% increase for White individuals.
  2. Inequality Exacerbates Overdose Rates: Areas with higher county-level income inequality witnessed more pronounced increases in overdose death rates, especially among Black persons, where rates were more than double in the highest versus lowest inequality counties.
  3. Low Substance Use Treatment Evidence Among Black Decedents: Evidence of previous substance use treatment was notably lowest among Black decedents (8.3%), highlighting significant disparities in access to care.
  4. Higher Death Rates in Areas with Greater Treatment Capacity: Counties with higher potential treatment and mental health provider capacity experienced the highest overdose death rates, particularly affecting Black and AI/AN persons and reflecting long-standing inequities in healthcare access.
  5. Naloxone Administration Variances: Naloxone administration rates were highest among AI/AN decedents (21.5%) and lowest among A/PI decedents (16.4%), indicating variability in emergency response measures.

Original Article Author and Citation

Corresponding Author

Mbabazi Kariisa,

Suggested Citation

Kariisa M, Davis NL, Kumar S, et al. Vital Signs: Drug Overdose Deaths, by Selected Sociodemographic and Social Determinants of Health Characteristics — 25 States and the District of Columbia, 2019–2020. MMWR Morb Mortal Wkly Rep 2022;71:940–947. DOI: 10.15585/mmwr.mm7129e2.


The study reveals significant disparities in drug overdose death rates among racial and ethnic groups in the United States, with marked increases from 2019 to 2020, especially among Black and AI/AN individuals. It highlights the role of socioeconomic factors and access to care in exacerbating these disparities.


Data from the State Unintentional Drug Overdose Reporting System (SUDORS) across 25 states and the District of Columbia were analyzed to examine overdose death rates by demographic and social determinants of health.


The findings underscore the critical need for evidence-based, culturally responsive, and equitable overdose prevention and response efforts. Addressing structural barriers and enhancing efforts such as linkage to care and harm reduction services are vital to reducing disparities.


Health disparities in overdose rates continue to worsen, especially among Black and AI/AN individuals. Strategies that are culturally responsive and address social determinants of health are urgently needed to mitigate these disparities and improve public health outcomes.

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