Racial and ethnic differences and COVID-19 pandemic-related changes in drug overdose deaths in North Carolina

To examine racial and ethnic differences and COVID-19 pandemic-related changes in key characteristics of drug overdose deaths in North Carolina. We used North Carolina State Unintentional Drug Overdose Reporting System data to describe specific drug-involvement, bystander presence, and naloxone administration for drug overdose deaths by race and ethnicity during pre-COVID-19 (May 2019–February 2020) and COVID-19 periods (March 2020–December 2020). For all racial and ethnic groups, drug overdose death rates and the percentage with fentanyl and alcohol involvement increased from the pre-COVID-19 to COVID-19 period, with fentanyl involvement highest among American Indian and Alaska Native (82.2%) and Hispanic (81.4%) individuals and alcohol involvement highest among Hispanic individuals (41.2%) during the COVID-19 period. Cocaine involvement remained high among Black non-Hispanic individuals (60.2%) and increased among American Indian and Alaska Native individuals (50.6%). There was an increase in the percentage of deaths with a bystander present from the pre-COVID-19 to COVID-19 period for all racial and ethnic groups, with more than half having a bystander present during the COVID-19 period. There was a decrease in the percentage of naloxone administered for most racial and ethnic groups, with the lowest percentage among Black non-Hispanic individuals (22.7%). Efforts to address increasing inequities in drug overdose deaths, including expanded community naloxone access, are needed. •Monthly rates of drug overdose death increased during the COVID-19 pandemic.•Rates were highest among American Indian/Alaska Native people.•Pandemic-related changes in specific drugs involved differed by race and ethnicity.•Bystander presence increased while naloxone administration decreased.•Efforts to ensure expanded and equitable community naloxone access are needed.