Abstract
Introduction: Opioid overdose death rates among African-Americans (AA) far exceed those of whites. We
examined differences in AA fatal overdose mortality and explored self-reported drug use and knowledge of opioid
overdose prevention among AA who use drugs in Massachusetts.
Methods: Analyses drew from statewide overdose mortality surveillance (SUDORS, N=5940) from 2017-2019
and the five-site Rapid Assessment of Consumer Knowledge (RACK) study conducted from August 2017 to
November 2019 (N=469). Death data included sociodemographic and toxicological variables. The RACK study
assessed drug use, harm reduction practices, and treatment experiences among people reporting past month
drug use, including 50 individuals who identified as AA. Chi-square tests and t-tests assessed differences by
race.
Results: Non-Hispanic Black decedents (n=318) were a median 12 years older than Black Hispanic decedents
(n=70). Fatal overdoses for AA tended to involve cocaine (62.0% vs 40.8%) and distinct fentanyl analogs (e.g.,
cyclopropylfentanyl), compared to white decedents. Similarly, AA survey participants were older (48.0% 41-55
years vs. 27.0%, p=0.002), and were more likely to be living in a house or apartment (60.0% vs. 38.5%, p=.006)
than non-AAs. Current injecting was lower in AAs (46.0% vs. 61.1%, p=.047) while oral use of opioid pain
medication was higher (100.0% vs. 70.6%, p=0.017). Naloxone knowledge and awareness did not differ by race.
However, AA participants had lower awareness that drugs may contain fentanyl prior to use (59.5% vs 75.9%,
p=0.045), or to have been trained to use naloxone (62.0% vs. 76.1%, p=0.038). AAs surveyed were less aware
of MA’s Good Samaritan Law (64.3% vs. 80.7%, p=.025).
Conclusions: We found racial differences in overdose mortality, drug risks, and knowledge about overdose
prevention among people who use drugs in MA. Findings suggest opportunities to empower AA people who use
drugs, especially by increasing access and training for naloxone and education about overdose prevention and
response.