Understanding Drug Mortality Increases Among Black Americans in the 2010s: The Role of Work Opportunities in the Local Labor Market

Background/Purpose: Black Americans experience some of the highest drug mortality risks, surpassing those of White Americans in 2020. These increases in drug mortality coincide with the rising crisis involving synthetic opioids (mostly, illicitly manufactured fentanyl [IMF]) since the early 2010s. IMF is mostly street supplied and disproportionately affects individuals in economically-disadvantaged communities. The social determinants of health literature emphasizes the importance of understanding the role of “deep-seated inequalities in living conditions, such as employment” in the newly-emerging drug epidemic trends. However, little empirical evidence exists to explain Black Americans’ greater risk of drug mortality and the role of local labor market opportunities. To fill these gaps, the present study tests the effects of work opportunities for Black Americans and potential interactions with fentanyl availability on their drug mortality changes since the early 2010s.

Methods: We used the National Center for Health Statistics’ restricted-access Multiple Cause of Death data (2010-2013 & 2018-2021), linked with county-level job, drug supply, and sociodemographic characteristics from the U.S. Census’s Longitudinal Employer-Household Dynamics Origin-Destination Employment Statistics (LODES), the Centers for Disease Control and Prevention (CDC), and American Community Surveys. The analytic sample included 214 counties reporting 10+ drug overdose deaths among Non-Hispanic Black individuals (i.e., the cutoff for non-suppressed death data per CDC) in 2010-2013. Our measures (all in first differences, i.e., the differences in the scores between 2010/2013 and 2018/2021) included the age-adjusted drug overdose mortality rates per 100,000 Black individuals (outcome), the ratio of jobs to Black workforce aged 18-64 (independent variable), the proportion of state-level drug seizures involving fentanyl (moderator), and sociodemographic controls (including opioid-prescribing rates). After examining the characteristics across counties by the extent of increases in Black Americans’ drug mortality, we estimated first-difference (FD) models to test the effects of job availability for the Black population and its interaction with state-level fentanyl seizures on drug overdose death rates.

Results: The top tercile of counties reported increases in the Black population’s drug mortality rates from 14.9 in 2010/2013 to 63.55 in 2018/2021, representing a 326% increase. These counties were primarily located in the Midwest/Northeast regions with a lower median household income. Our FD model without interaction suggests that a 1% increase in job availability for the Black workforce was associated with a reduction of 0.33 drug overdose deaths among Black populations (b = -33.05, p < .05). Our final FD model shows statistically significant moderating effects (b = -2.02, p < .001), implying that job availability had greater protective effects on drug mortality among Black populations in areas with a higher proportion of fentanyl seizures.

Conclusions and Implications: Increases in Black Americans’ drug mortality in the 2010s were not uniformly distributed across U.S. counties. Compared to Southern counties, those in the Midwest and Northeast, especially those with lower income, reported higher increases in drug mortality among Black populations. Findings suggest that promoting local labor market opportunities for Black Americans, especially in areas where fentanyl is more prevalent, may contribute to the prevention of drug mortality, potentially narrowing racial/ethnic differences in drug mortality.