Substance Use Related Deaths Among Racial/Ethnic Groups in the United States: Findings from the National Violent Death Reporting System

Background: Despite increased focus on how social disparities influence health outcomes, large differences in violent death rates (homicide and suicide) persist among racial/ethnic minorities. Additionally, current substance use research shows that more than half of all persons who experience violent death test positive for psychoactive substances. While the current focus on substance use related violent death concerns opioid use in primarily rural, predominantly White non-Hispanic communities, there is little to no knowledge base for how substance use related violent death differs among different racial/ethnic groups. In order to establish a knowledge base within these areas of research, we examine how race/ethnicity intersects with substance use behavior to influence rates of violent death from the years 2003-2015.

Method: Data is from the National Violent Death Reporting System (NVDRS), which includes all violent deaths from 27 states in the U.S., collected each year from 2003 to 2015 (N = 135,310). NVDRS data includes reports from death certificates, as well as coroner, law enforcement and toxicology reports. To establish substance use related violent deaths, four binary dependent variables were created to identify persons who had experienced an opioid, alcohol, amphetamine or marijuana-related violent death. Additional measures in the NVDRS include race/ethnicity, age, gender, education, marital status, mental health problems, history of substance use, the experience of interpersonal violence, and history of suicide. To examine whether there are racial/ethnic differences in substance-use related violent deaths, four fixed-effects multivariate logistic regression models examined whether a race/ethnicity by time interaction term was associated with each substance use related violent death measure (opioids, alcohol, methamphetamine and marijuana), controlling for additional factors associated with violent death.

Results: Among opioid-related fatalities, there was a significant increase amongst all groups over time, and a significant race/ethnicity by time interaction, suggesting that the rate of increase over time for opioid-related deaths was larger among racial and ethnic minorities compared to White non-Hispanic individuals. This pattern resulted in little differences across racial/ethnic groups by the year 2015. Among alcohol-related, methamphetamine-related and marijuana-related deaths, there was also a significant increase among all groups over time, but the significant race/ethnicity by time interactions showed a consistent widening of differences such that racial/ethnic minorities had larger odds of these substance use related deaths by 2015, compared to White non-Hispanic individuals.

Discussion: While the current focus on substance use related deaths concerns opioid use among specific groups of individuals, this research suggests this concern is warranted across all racial/ethnic minority groups. Additionally, racial/ethnic minority groups experience elevated substance use related deaths across other substances as well. Current directions in social work practice especially those with a focus on addictions, may benefit from this work, which calls attention to the heightened risk substance using racial/ethnic minority individuals may face. Additionally, social work practitioners of all areas can build from this work to continue advocacy for increased effort to better understand the links between racial/ethnic groups and social disparities in health.