Overdose deaths involving synthetic opioids: Racial/ethnic and educational disparities in the eastern and western US

This study examined racial/ethnic and educational disparities in US synthetic opioid overdose mortality East and West of the Mississippi River. Using restricted-access 2018–2021 mortality data from the Centers for Disease Control and Prevention and population estimates from the American Community Survey, age-standardized rate ratios (SRRs) and 95% Confidence Intervals (CIs) were used to compare rates of synthetic opioid mortality by race/ethnicity and educational attainment level in the regions East and West of the Mississippi River. Racial/ethnic disparities in synthetic opioid mortality rates, relative to the Non-Hispanic (NH) White population, were observed in the NH Black (SRR, 1.5 [95% CI, 1.5–1.6]) and NH American Indian/Alaska Native (SRR, 2.1 [95% CI, 1.9–2.2]) populations in the West, and the Puerto Rican (SRR, 1.3 [95% CI, 1.3–1.3]) and NH American Indian/Alaska Native (SRR, 1.5 [95% CI, 1.4–1.6]) populations in the East. Relative to those with a Bachelor’s degree or higher: in the West, the synthetic opioid mortality rate was more than seven times as high for those with a high school diploma only (SRR 7.7 [95% CI, 7.4–8.0]), and in the East, approximately thirteen times as high for those with a high school diploma only (SRR, 13.0 [95% CI, 12.7–13.3]) or less than a high school diploma (SRR, 13.3 [95% CI, 13.0–13.7]). Disparities in rates of synthetic opioid mortality differ in the eastern and western US, supporting tailored responses within each region. •Disparate synthetic opioid mortality rates in Puerto Ricans, East of the Mississippi River.•Disparate rates in Non-Hispanic Black population, West of the Mississippi River.•Disparate rates in Non-Hispanic American Indian populations, both East and West.•Rates multiple times higher in lower, compared to highest, educational levels..