Since 2001, male deaths from drug overdose have increased almost sixfold, and now account for a third of male fatal injuries, up from around one-tenth. (For more details on overall trends in accidental deaths, see our earlier brief “Unnatural Male Deaths: Fatal Injuries and the Rise of Drug Overdoses”).

Between 2008 and 2016, Black men had substantially lower overdose rates compared to white and AI/AN men. By 2018, the Black male drug death rate (28 per 100,000) had nearly converged with white and AI/AN men (both 30 per 100,000). In the years that followed, rates among Black and AI/AN men rose sharply, far exceeding other racial groups.

By 2022, AI/AN men had the highest age-adjusted drug death rate at 81 per 100,000, followed closely by Black men at 69 per 100,000 – rates that are 80% and 53% higher, respectively, than white men. While the national age-adjusted drug overdose death rate slightly decreased in 2023 (from 32.6 per 100,000 in 2022 to 31.3), the rate among the Black population continued to rise (47.5 to 48.9).
 

Figure 1

Race and age

Among Black men, those aged 55-64 experience the highest overdose death rates, followed by those aged 45-54. Black men aged 45-64 were 2.3 times as likely to die compared to similarly-aged white men. As shown in Figure 3, the risk of overdose mortality among white men starts to decline by age 45, while Black men’s risk continues to rise until age 65. Black men aged 65 and over were 5.6 times as likely to die by drug overdose compared to their white peers.
 

Figure 3

A recent New York Times article highlights how these dynamics have devastated a whole generation of Black men, destabilizing families and communities. It discusses the significant barriers older Black men face when accessing addiction treatment and gold-standard medications for opioid use disorder. Medicare’s reduced coverage for addiction services, combined with harm reduction programs that often target younger populations, leaves older men underserved despite their unique challenges and higher risks.

Why are Black men now at higher risk?

Drug abuse and overdose deaths are influenced by a range of factors, including economic instability, housing challenges, interpersonal trauma, and access to healthcare. An important question for health practitioners and policymakers is why the death rates for Black men have risen so rapidly in recent years. Possible explanations include:

• Opioids changed: The overdose epidemic initially emerged from the overprescription of opioids in rural and suburban areas, predominantly impacting non-urban white populations. However, as efforts to curb prescription opioid misuse took effect, potent synthetic opioids like fentanyl entered the illicit drug market, disproportionately affecting urban areas and Black communities.
• Diverging economic prospects: There is a strong connection between unemployment and overdose mortality in Black workers, according to a study by Ohio State University. Economic instability not only limits access to healthcare and addiction treatment but also exacerbates stress and feelings of hopelessness, increasing the likelihood of substance use. Job growth, in contrast, showed a “stronger protective effect” against overdose deaths.
• Less likely to complete treatment: Black individuals are less likely to complete substance use treatment, according to some research. Housing instability and unemployment mostly explain these differences in completion rates.
• Less Appropriate Care: Even when treatment is accessed, Black patients are less likely to receive evidence-based rehabilitation services, including medication-assisted treatment (MAT). Black patients were half as likely to obtain treatment following an overdose compared to white patients even when privately insured, according to a study.
• COVID-19: The pandemic worsened existing social determinants of health, especially for older Black men. Health concerns, disruptions to addiction services, and prolonged isolation may have compounded overdose vulnerabilities.
• Limited Access to Naloxone: Naloxone (Narcan) is a critical tool in preventing fatal overdoses, but its accessibility varies significantly by race. Data shows that fewer Black men have access to the life-saving benefits of Naloxone because of unequal distribution and over-the-counter costs.
• Fear of Arrest: Many Black men avoid seeking addiction treatment due to fear of incarceration and mistrust of healthcare and justice systems. The legacy of harsh drug policies left Black men representing a substantial percentage of drug offenders in federal prison.

The levels of male deaths from drug overdose have risen to crisis levels. As we showed in our earlier brief, the increase in deaths since 2001 equates to the loss of an additional 400,000 lives, about the same as the number of U.S. men who died in World War II. But the racial pattern of drug deaths has also shifted, with Black and AI/AN men now at the highest risk.