Addiction doesn’t discriminate: anyone from every ethnicity, cultural background, and class can experience the struggles of opioid use disorder (OUD). So why have opioid overdose deaths been rising in the Black community in recent years? The numbers are alarming: the Pew Research center has noted that opioid overdose deaths in Black men have tripled since 2015, and while the rates in Black women are lower, both Black men and women experienced higher death rates than their white counterparts.1
It wasn’t always like this. White Americans have historically garnered the most attention as the opioid epidemic gained steam since the late 90s. Purdue Pharma, the infamous pharmaceutical company behind Oxycontin, even focused all of their marketing efforts in mostly white communities.2 Not surprisingly, overdose deaths were more prominent for individuals in those communities, at least until Black individuals started outpacing them in the late 2010s.3
Media coverage focused their reporting in those areas as well, expressing shock at how addiction was prevalent in white, suburban, and affluent communities rather than in Black, urban, and poor communities, largely portraying the epidemic as something that mostly impacts white Americans. On the other hand, Black Americans were more likely to be portrayed as criminals, with stories less sympathetic about their OUD struggles.4 This is the likely outcome of the criminalization approach to the war on drugs which has impacted communities of color with disproportionately high incarceration rates compared to white drug offenders.5
This framing doesn’t help when Black individuals also face outdated misconceptions from their healthcare providers, a majority of which still believe that their Black patients suffer less pain than their white patients.6 Naturally, those views impact the way that their patients receive care. Black patients were less likely to receive an opioid prescription since the start of the epidemic, which explains why their overdose rates weren’t as high.7 But that changed in the 2010s as Black Americans fatally overdosed on synthetic opioids at higher rates than white Americans.8
Even with these high rates, however, those in the Black community may find additional challenges in accessing treatment programs for their OUD. They are less likely to have access to opioid treatment drug buprenorphine, which is primarily restricted to patients with insurance or private pay (which Black people are less likely to have access to).9 10 This is significant, as buprenorphine is allowed to be taken home while methadone has been primarily restricted to multiple, supervised in-person visits until recently — a difference that is more than likely to impact progress. Because the COVID-19 pandemic forced many treatment programs to adopt a telemedicine model, methadone restrictions have finally relaxed with no discernable impact on patient outcomes.11 But with current shortages of both methadone12 and buprenorphine13, Black patients may see no positive change in accessing treatment programs.
Just like addiction, racism can appear where it’s not expected or appropriately identified until it becomes an issue too late to address. However, they aren’t mutually exclusive to one another. People can be racist — addiction can’t. The sooner we realize that, the better the outcomes will be for individuals that are already discriminated against and marginalized in all aspects of their lives. It’s about time that treatment programs recognize this disparity so the victims with OUD can have equal access to care.
1 Recent surge in U.S. drug overdose deaths has hit Black men the hardest
2 White opioids: Pharmaceutical race and the war on drugs that wasn’t – PMC
3 African Americans now outpace whites in opioid‐involved overdose deaths: a comparison of temporal trends from 1999 to 2018 – Furr‐Holden – 2021 – Addiction – Wiley Online Library
4 The War on Drugs That Wasn’t: Wasted Whiteness, “Dirty Doctors,” and Race in Media Coverage of Prescription Opioid Misuse
5 The Drug War, Mass Incarceration and Race (English/Spanish) | Drug Policy Alliance 6
6 Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites | PNAS
7 Trends in Prescription Opioid and Nonopioid Analgesic Use by Race, 1996–2017 – American Journal of Preventive Medicine
8 Differences in Opioid Overdose Mortality Rates Among Middle-Aged Adults by Race/Ethnicity and Sex, 1999-2018 – Rachel A. Hoopsick, Gregory G. Homish, Kenneth E. Leonard, 2021
9 Buprenorphine Treatment Divide by Race/Ethnicity and Payment | Health Disparities | JAMA Psychiatry
10 Addressing racial & socioeconomic disparities in access to medications for opioid use disorder amid COVID-19 – PMC
11 The impact of relaxation of methadone take-home protocols on treatment outcomes in the COVID-19 era
12 Methadone Access for Opioid Use Disorder During the COVID-19 Pandemic Within the United States and Canada | Addiction Medicine | JAMA Network Open
13 Racial and Ethnic Disparities in Buprenorphine and Extended-Release Naltrexone Filled Prescriptions During the COVID-19 Pandemic
