SOCIAL EM & POPULATION HEALTH
A Harm Reduction Approach to Racial Disparities in Overdose Deaths: The Role of Smoking Supplies in Emergency Care
SAEM PULSE | MAY-JUNE 2025
By Seamus Vahey and Karri Weisenthal, MD, MHS on behalf of the SAEM Social EM & Population Health Interest Group
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The Centers for Disease Control and Prevention (CDC) recently released data indicating an overall decline in drug-related overdose deaths. Total overdose deaths in 2024 are projected to decrease by more than 20,000 compared to 2023. This progress can be attributed to several factors, including expanded access to medications for opioid use disorder, naloxone, and syringe service programs. The critical work of peer support workers and community health workers—who respond to overdoses and save lives every day—also plays a significant role.
However, while the overall trend is encouraging, the data do not reflect the ongoing racial disparities in overdose deaths. Notably, overdose mortality rates have increased among Black, Latinx, and American Indian/Alaska Native populations, as well as among individuals who primarily smoke substances rather than inject them. These disparities reflect longstanding inequities exacerbated by the effects of the war on drugs, which have resulted in fewer resources for substance use treatment and support in many communities of color. The continued criminalization of substance use
further compounds these challenges, contributing to gaps in access to care and overdose prevention compared to white populations. Emergency departments (EDs) are uniquely positioned to help address the overdose crisis. People who use drugs (PWUD) account for a disproportionately high number of ED visits, often presenting with soft tissue infections, overdoserelated complications, or in need of detoxification services. These encounters present critical opportunities for harm reduction interventions.