"Survivors" of the Opioid Crisis: Epidemiological Paradox and Negative Equality in Overdose Deaths Among Patients with Chronic Musculoskeletal Diseases, 1999–2020

"Survivors" of the Opioid Crisis: Epidemiological Paradox and Negative Equality in Overdose Deaths Among Patients with Chronic Musculoskeletal Diseases, 1999–2020 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article "Survivors" of the Opioid Crisis: Epidemiological Paradox and Negative Equality in Overdose Deaths Among Patients with Chronic Musculoskeletal Diseases, 1999–2020 Pingfeng Yin, Lan Wang, Duo Zhao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8816036/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background. The U.S. opioid crisis has shifted from prescription to illicit sources, yet the long-term mortality trajectory for patients with chronic musculoskeletal conditions (CMC)—the original target of prescribing controls—remains understudied. We aimed to reconstruct overdose mortality trends for CMC patients (1999–2020) and examine structural racial and geographic disparities. Methods. We conducted a retrospective cohort study using CDC WONDER data. We analyzed trends in opioid overdose deaths among CMC patients aged 25–84 years using Joinpoint regression and quantified racial inequalities using Rate Ratios (RR) and Rate Differences (RD). Results. Contrary to national fentanyl-driven surges, CMC opioid mortality declined significantly by 12.8% annually post-2013. This "epidemiological paradox" suggests strict medical controls created "iatrogenic insulation" against illicit markets. Although the White-to-minority mortality gap narrowed significantly (RR from 5.0 to 1.8), this convergence was driven by risk regression among Whites rather than improvements for minorities, representing "Negative Equality." Rural areas experienced asymmetric declines due to severed access, despite persisting "medical deserts." Conclusions. Strict supply-side interventions effectively reduced overdose deaths among CMC patients but masked persistent structural inequities. Public health policy must shift from generalized restriction to targeted health equity interventions, ensuring the narrowing of racial gaps reflects genuine health improvements rather than shared deprivation. Opioid Crisis Chronic Musculoskeletal Conditions Iatrogenic Insulation Negative Equality Racial Disparities Medical Deserts Full Text Additional Declarations No competing interests reported. Supplementary Files SupplementaryMaterial1.doc SupplementaryMaterial2.doc SupplementaryMaterial3.doc Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 15 Apr, 2026 Reviews received at journal 17 Mar, 2026 Reviewers agreed at journal 09 Mar, 2026 Reviewers agreed at journal 13 Feb, 2026 Reviewers invited by journal 13 Feb, 2026 Editor invited by journal 12 Feb, 2026 Editor assigned by journal 11 Feb, 2026 Submission checks completed at journal 11 Feb, 2026 First submitted to journal 07 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8816036","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":592900406,"identity":"091552cd-b022-4469-b466-b7be76a8200c","order_by":0,"name":"Pingfeng Yin","email":"","orcid":"","institution":"The First People's Hospital of Guannan: Lianyungang","correspondingAuthor":false,"prefix":"","firstName":"Pingfeng","middleName":"","lastName":"Yin","suffix":""},{"id":592900407,"identity":"f7b7152a-cb65-4fe0-bbca-ff62795d5175","order_by":1,"name":"Lan Wang","email":"","orcid":"","institution":"Huai'an 82 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We aimed to reconstruct overdose mortality trends for CMC patients (1999–2020) and examine structural racial and geographic disparities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods.\u003c/strong\u003e We conducted a retrospective cohort study using CDC WONDER data. We analyzed trends in opioid overdose deaths among CMC patients aged 25–84 years using Joinpoint regression and quantified racial inequalities using Rate Ratios (RR) and Rate Differences (RD).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults. \u003c/strong\u003eContrary to national fentanyl-driven surges, CMC opioid mortality declined significantly by 12.8% annually post-2013. This \"epidemiological paradox\" suggests strict medical controls created \"iatrogenic insulation\" against illicit markets. 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Public health policy must shift from generalized restriction to targeted health equity interventions, ensuring the narrowing of racial gaps reflects genuine health improvements rather than shared deprivation.\u003c/p\u003e","manuscriptTitle":"\"Survivors\" of the Opioid Crisis: Epidemiological Paradox and Negative Equality in Overdose Deaths Among Patients with Chronic Musculoskeletal Diseases, 1999–2020","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-18 02:54:58","doi":"10.21203/rs.3.rs-8816036/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"300316892142964468294202020125434518652","date":"2026-04-15T14:45:20+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-17T21:57:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"304061145762893414930870963266919816996","date":"2026-03-09T15:26:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"249047312977374558046311596399058323222","date":"2026-02-13T12:51:12+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-13T09:13:30+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-12T08:21:59+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-11T23:16:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-11T23:15:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2026-02-07T14:01:42+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d5b36e72-513f-4c75-b87f-d569bcb78444","owner":[],"postedDate":"February 18th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-18T02:54:58+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-18 02:54:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8816036","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8816036","identity":"rs-8816036","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}