{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T23:20:02Z","timestamp":1794093602374,"version":"4.8.0"},"reference-count":39,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2022,4,8]],"date-time":"2022-04-08T00:00:00Z","timestamp":1649376000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["5R61DA049382-02"],"award-info":[{"award-number":["5R61DA049382-02"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,3,4]]},"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The rate of drug overdose deaths in the USA has more than tripled since the turn of the century, and rates are disproportionately high among the American Indian\/Alaska Native (AI\/AN) population. Little is known about the overall historical trends in AI\/AN opioid-only and opioid\/polysubstance-related mortality. This study will address this gap.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>This is a retrospective longitudinal ecological study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>US death records from 1999 to 2019 using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>US non-Hispanic AI\/AN people age 12 years and older.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measures<\/jats:title>\n                    <jats:p>The primary outcomes, identified via the 10th revision of the International Statistical Classification of Diseases and Related Health Problems codes, included overdose deaths due to (1) opioids only, opioids in combination with any other substance, all-opioid related overdoses; (2) combinations of opioids and alcohol, opioids and methamphetamine, opioids and cocaine, opioids and benzodiazepines; and (3) specific types of opioids.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From 1999 to 2019, opioid-only mortality rates increased from 2.8 to 15.8 per 100\u2009000 (p&lt;0.001) for AI\/AN women and 4.6 to 25.6 per 100\u2009000 (p&lt;0.001) for AI\/AN men. All opioid-related mortality rates increased significantly (p&lt;0.001) from 5.2 to 33.9 per 100\u2009000 AI\/AN persons, 3.9 to 26.1 for women and 6.5 to 42.1 for men. AI\/AN also exhibited significant increases in mortality rates due to opioids and alcohol, opioids and benzodiazepines, opioids and methamphetamine, and AI\/AN men experienced substantial increases in mortality due to opioids and cocaine. Mortality rates by individual opioid types increased significantly over time for heroin, natural and semi-synthetic (prescription), and synthetic opioids (fentanyl\/fentanyl analogues) other than methadone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings highlight magnification over time in opioid-related deaths and may point to broader systemic factors that may disproportionately affect members of AI\/AN communities and drive inequities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-053686","type":"journal-article","created":{"date-parts":[[2022,5,2]],"date-time":"2022-05-02T20:00:22Z","timestamp":1651521622000},"page":"e053686","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":40,"title":["Epidemiological trends in opioid-only and opioid\/polysubstance-related death rates among American Indian\/Alaska Native populations from 1999 to 2019: a retrospective longitudinal ecological study"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3376-220X","authenticated-orcid":false,"given":"Fares","family":"Qeadan","sequence":"first","affiliation":[{"name":"Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin F","family":"Madden","sequence":"additional","affiliation":[{"name":"Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nana A","family":"Mensah","sequence":"additional","affiliation":[{"name":"Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0620-0858","authenticated-orcid":false,"given":"Benjamin","family":"Tingey","sequence":"additional","affiliation":[{"name":"Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7161-8970","authenticated-orcid":false,"given":"Jalene","family":"Herron","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Hernandez-Vallant","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamilla L","family":"Venner","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"English","sequence":"additional","affiliation":[{"name":"Albuquerque Area Southwest Tribal Epidemiology Center (AASTEC), Albuquerque Area Indian Health Service, Albuquerque, New Mexico, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amruta","family":"Dixit","sequence":"additional","affiliation":[{"name":"Albuquerque Area Southwest Tribal Epidemiology Center (AASTEC), Albuquerque Area Indian Health Service, Albuquerque, New Mexico, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,5,2]]},"reference":[{"key":"2025121401452556000_12.5.e053686.1","unstructured":"Hedegaard H , Mini\u00f1o AM , Warner M . 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