Racial and ethnic differences in alcohol-, opioid-, and co-use-related deaths in Washington State from 2011 to 2017

Background: Few studies exist examining alcohol and opioid co-use mortality rates among racially and ethnically diverse communities, presenting a critical gap in understanding the contribution of alcohol on opioid-related deaths and strategies for prevention. The purpose of the study was to assess whether alcohol and opioid-related deaths differ by race/ethnicity subgroups and if there has been an increase in alcohol and opioid-related deaths between 2011 and 2017. Design: Secondary data analysis of publicly available alcohol and opioid mortality data among non-Hispanic Whites, Black, Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native individuals in Washington State. Measurements: The primary outcomes were alcohol-only, opioid-only, and alcohol-opioid co-use mortality, 2011–2017. Alcohol and/or opioid-related deaths were assigned an International Statistical Classification of Diseases and Related Health Problems (ICD-10) code for the underlying or multiple cause of death. Findings: Between 2011 and 2017, alcohol-only mortality rates increased among non-Hispanic White (P = 0.003) and Hispanic individuals (P = 0.008). Opioid-only mortality rates increased among American Indian/Alaska Native (P = 0.004) and Hispanic individuals (P = <0.001). American Indian/Alaska Native individuals had the highest alcohol-only, opioid-only, and co-use-related mortality rates when looking at between-group incidence rates. Conclusions: Although the opioid epidemic has been characterized as a public health crisis that predominantly impacts non-Hispanic White individuals, racial and ethnic minorities are increasingly impacted by fatal and non-fatal overdose related to co-occurring substance use. Our findings using data from Washington State, align with existing data and signal a dire need to address alcohol and opioid misuse through targeted interventions to prevent overdose and poisoning, with special considerations for American Indian/Alaska Native communities.