Research

Female Veterans, Veterans from Racial and Ethnic Minority Groups at Higher Risk of Dying from Opioid Overdose

By uncovering differences in opioid overdose death by sex and race/ethnicity, clinicians can shape more personalized and effective care that saves lives and promotes long-term recovery

Prior studies have shown veterans are particularly at risk of dying by opioid overdose and the possibility of that occurring has been rising steadily over the past two decades. From 2010-2019, there was a 61.2% increase in risk of overdose death among male veterans. Interestingly, this increased risk was not observed among female veterans, despite rates of opioid use disorder (OUD) rising more quickly among women than men in the general population. Racial disparities in opioid overdose deaths are also prominent with a significant increase in death due to opioids among all racial and ethnic minority veterans, except American Indian or Alaskan Native veterans.

Given increases in opioid overdose rates and policy changes expanding access to medications for OUD during the COVID-19 pandemic, BU and VA researchers sought to understand how the opioid overdose epidemic impacted veterans with opioid use disorder. In their new study, they found female veterans and veterans from racial and ethnic minority groups were at higher risk of dying from an opioid overdose than other veterans.

“These findings are novel because prior research has not comprehensively examined how overdose mortality patterns vary simultaneously by sex and race/ethnicity among veterans with opioid use disorder, nor how these disparities shifted during a period of major healthcare disruption such as the COVID-19 pandemic,” explained co-corresponding author Amar Mandavia, PhD, an instructor in psychiatry at Boston University Chobanian & Avedisian School of Medicine and an investigator in the Behavioral Health Sciences division of the National Center for PTSD at VA Boston Healthcare System.

The researchers reviewed medical records from more than 200,000 veterans who had been diagnosed with OUD between 2016 and 2021. They noted who died, what they died from and their age, sex and race. They then conducted statistical tests to see who was most at risk of dying from an opioid overdose—comparing males and females, different age groups and different races and ethnicities. Their findings revealed that younger, female, and racially and ethnically minoritized veterans are experiencing opioid overdose deaths at disproportionately high rates compared to White males, particularly during times of healthcare system stress.

According to the researchers, these findings underscore the urgent need for targeted approaches to overdose prevention and OUD treatment. “Clinically, these findings call for the expansion of tailored treatment models, improved access to medications for OUD, targeted overdose prevention efforts, and enhanced outreach to high-risk veterans,” says co-corresponding author Nicholas Livingston, PhD, assistant professor of psychiatry at the school and a research psychologist at the National Center for PTSD at the VA.

The researchers hope this study will help ensure that no veteran, regardless of sex or race is left behind in the fight against the opioid epidemic.

These findings appear online in the journal Drug and Alcohol Dependence.