Examining social and biological determinants of health driving opioid and stimulant involved deaths among black people in St. Louis, MO

The fourth wave of the opioid crisis—characterized by co-use of opioids (namely illicit fentanyl) and stimulants– has exacerbated the risk of fatal overdose. The effects of co-involved opioid and stimulant use have been particularly stark among Black people in the U.S., who demonstrated increases in fatal overdose rates involving fentanyl and cocaine beginning in 2018. There is an urgent need to identify drivers and risk factors for opioid, stimulant, and co-opioid and stimulant-involved deaths among Black people. The current study aimed to identify social and biological health determinants associated with opioid, stimulant, and co-involved opioid and stimulant deaths among Black people in St. Louis, MO. Analyses included data from 1,844 Black decedents, aged 18–86 whose deaths were determined to be opioid and/or stimulant-involved between 2016 and 2023. Analyses included a series of chi-square tests of association and a multinomial logistic regression. Deaths among older Black males with at least one chronic medical (particularly cardiovascular) condition had greater odds of involving stimulants, whereas those among younger Black males had greater odds of involving opioids and co-involved opioids and stimulants. Most decedents resided in highly disinvested neighborhoods. The results highlight the need to develop and test differential targets for prevention and outreach between younger and older Black males who use different types of drugs and are in varying degrees of physical health.