Geography And Fentanyl: Explaining The Disproportionate Rise In Opioid Overdose Deaths Among Black Americans

This study investigated how geography helps explain the striking increase in opioid-related overdose deaths among Black Americans since the proliferation of fentanyl. Using mortality data from the period 1999–2020, we modeled annual overdose rates as a function of race and ethnicity and county of residence to identify the share of racial differences in overdose rate growth that could be attributed to location. Geographic incidence contributed little to racial and ethnic overdose disparities before 2013 but became an important factor during the fentanyl crisis. Between 2010 and 2020, roughly 40 percent of the additional growth in Black opioid-related overdoses versus White overdoses was attributable to differential geographic exposure to the fentanyl crisis. Overdoses involving opioids but not cocaine are largely attributed to geography, whereas overdoses involving both opioids and cocaine show a smaller geographic component. These findings underscore a possible role for place-based interventions to affect racial and ethnic disparities in overdose rates.