Driving Factors of the Opioid Crisis
How identity shapes experience
Systemic disparities across race, ethnicity, age, and sex significantly influence opioid outcomes—from overdose fatality rates to treatment access and efficacy. Understanding how identify shapes experience is key in ensuring that prevention, treatment, and recovery programs are accessible and responsive to the needs of those who are most impacted.
Race and ethnicity
Opioid overdose deaths have been rising most sharply among Black Americans in recent years, particularly older Black men. From 2015 to 2017, Black adults aged 45–54 in metropolitan areas saw opioid-related death rates surge dramatically.¹ A 21-year study found that by 2019, non-Hispanic Black men aged 55 and older had an opioid overdose death rate nearly four times the overall rate for that age group.² Structural barriers also restrict access to quality treatment: Black and Hispanic Medicare beneficiaries were significantly less likely than White beneficiaries to receive take-home methadone.³
Age
Overdose mortality has climbed steeply among older adults. Opioid overdose deaths among people aged 55+ rose roughly tenfold from 1999 to 2019, reflecting increased vulnerability due to chronic conditions and polypharmacy.⁴ Among younger populations under the age of 35, rates of overdose have seen recent decreases while rates for all other ages groups have climbed.⁵
Sex and gender
Males consistently account for more opioid-related overdose deaths—the overdose fatality rate among men between 2020 and 2021 was 2 to 3 times higher than among females.⁶ Yet, women are more likely than men to be prescribed opioid painkillers, often at higher doses and for longer durations, increasing their risk for dependence and overdose.⁷ Additionally, women's opioid-related hospitalizations and overdose rates have been increasing faster in recent years, reflecting evolving vulnerabilities tied to chronic pain, mental health, and caregiving burdens.⁸ Between 1999 and 2015, the prescription opioid overdose death rate among women increase 471% - compared to an increase of 218% among men.¹⁰
These demographic disparities shape not only risk but also treatment outcomes, such as the likelihood of being referred for addiction services or naloxone access upon discharge from the hospital following an opioid overdose.¹¹
Risk and Protective Factors driving opioid use
Many factors drive opioid use, contributing to the ongoing epidemic. Overprescribing of opioids for pain management has played a significant role, often leading to misuse and dependency among patients. Poor mental health, including depression, anxiety, and trauma, further increases vulnerability to opioid use as individuals may turn to substances to cope with emotional distress. Additionally, the misuse of other substances, such as alcohol or stimulant use, heightens the risk of developing opioid dependency due to overlapping behaviors and compounded health challenges. These interconnected risk factors create a cycle of vulnerability that underscores the need for comprehensive approaches, including responsible prescribing practices, integrated mental health and substance use treatment, and prevention strategies to address the root causes of opioid misuse.
Protective factors also play a crucial role, as they can reduce the likelihood of engaging in opioid use and support treatment and recovery outcomes. Access to evidence-based prevention, treatment and recovery services, such as medication-assisted treatment (MAT) and counseling, is essential for preventing misuse and addressing dependency. Developing strong coping skills helps individuals manage stress, trauma, and other challenges without turning to substances. Additionally, robust social supports—such as family, friends, and community networks—provide emotional encouragement and reduce feelings of isolation, preventing individuals from turning to substances to cope and fostering accountability for those in recovery. These protective factors work together to create a foundation for resilience, reducing the likelihood of opioid misuse and promoting long-term well-being. Expanding access to these resources and strengthening protective systems can significantly impact efforts to combat the opioid epidemic.