The opioid epidemic in the U.S. is among the most significant public health issues of our time. Over the years, hundreds of thousands of lives have been claimed through overdose deaths involving natural opioids, synthetic opioids, and the illicit drug heroin.
Opioid addiction has touched nearly all parts of the U.S., and the epidemic reaches far and wide, affecting diverse populations. This includes the nation’s Black communities, which, like many others, are grappling with the challenges of opioid use disorder and addiction.
Statistics from over the years paint a grim picture of how serious opioid addiction is and how it continues to affect the nation. In 2019, nearly 50,000 people in the U.S. died from opioid-related overdoses, the National Institute on Drug Abuse (NIDA) reports. That same year, an average of 38 people died every day from overdose deaths involving prescription opioids, according to the U.S. Centers for Disease Control and Prevention (CDC).
With the years-long battle to help people fight back against opioid addiction, researchers and others say it is time to focus on inclusive ways to help all groups achieve sobriety. The coronavirus pandemic of the past year has helped bring to light how Black communities are struggling with opioid addiction and what needs to be done to help them move forward.
Rise in Overdose Deaths Among Blacks Seen During Pandemic
The United States was hit with another crisis in 2020—the coronavirus pandemic—while battling opioid addiction, and the intersection of both health emergencies has complicated each one in various ways.
Preliminary federal data from the CDC shows that at least 87,203 Americans died from drug overdoses by September 2020, with the CDC predicting that the figure could rise to 90,000 when reporting is completed. The federal health agency’s director, Robert Redfield, M.D., said in a news release that the pandemic’s disruption to daily life hit people with substance use disorders hard. The news release also reported that synthetic opioids, such as fentanyl, were the main reason behind the increases.
Some of these fatal overdoses have been documented to have taken place in Philadelphia’s Black community. Overdose deaths rose more than 50% among the city’s Black residents in 2020, Dr. Utsha Khatri, a University of Pennsylvania researcher, told National Public Radio (NPR) for its recent article profiling drug overdose deaths among Black Americans.
“It wasn’t until we started looking at the level of race and ethnicity that we realized Black and brown communities are being disproportionately affected,” Khatri told NPR.
Opioid Deaths Affected Black Communities Before COVID-19
Various data sources report that opioid overdose death rates in Black communities have sharply increased during recent years. One source that shares research on the topic is the Substance Abuse and Mental Health Services Administration (SAMHSA)’s report titled, “The Opioid Crisis and the Black/African American Population: An Urgent Issue.”
The report’s authors say much of the data presented in the report is a snapshot of what is happening in Black/African American communities, not a fully developed picture of this demographic across the U.S. Still, the data offers an examination into the issues affecting this population.
Many Overdose Deaths Involved Synthetic Opioids
SAMHSA’s report points to data showing that synthetic opioids are affecting overdose death rates among non-Hispanic Blacks at higher rates than other populations. Synthetic opioids are substances made in a laboratory to imitate natural opioids. They affect the same parts of the brain as those substances do, as the Drug Enforcement Administration (DEA) explains. Natural opioids are morphine and codeine, while synthetic opioids are drugs like methadone and fentanyl.
Synthetic substances offer pain relief and have helped many people manage their pain. They are also abused for their effects, which include euphoria, relaxation, and drowsiness. They also can cause people to feel ill, confused, and sedated. Heavy sedation can depress breathing to the point where users’ may never wake up or suffer permanent injuries when they do.
“Synthetic opioids accounted for nearly 70 percent of the opioid-related overdose deaths and 43 percent of the total drug overdose deaths for non-Hispanic Blacks in 2017,” SAMHSA’s reports says, highlighting data from the CDC’s National Vital Statistics System.
Fentanyl, in both its illegal and prescription forms, is believed to be the primary synthetic behind the spike in opioid drug deaths that have left many health officials, law enforcement, and others seeking answers—and solutions.
According to the CDC’s data, synthetic opioids other than methadone increased 818% between 2014 and 2017 among the non-Hispanic Black population in the U.S. This was also the highest rate among all other races and ethnicities, the report says. In 2017, 3,832 non-Hispanic Black people overdosed and died after using synthetic opioids other than methadone, CDC data show.
There was a 230% increase involving any opioid, and heroin drug overdose deaths increased 196% for this population in this three-year period. Data also show which states had the highest number of non-Hispanic Black populations that had opioid overdose deaths. The top five states in 2018 were:
- Maryland – 709
- Illinois – 598
- New Jersey – 459
- Michigan – 426
- Ohio – 402
Not all states had data available for opioid use among non-Hispanic Blacks, but authors of the SAMHSA report write, “Regardless of how the data are represented, it is clear that Black/African Americans across the U.S. are substantially affected by the opioid crisis.”
How Opioid Misuse, Overdose Happen in Black Communities
Opioid use and misuse lead to overdose and death in various ways. Multiple pathways to using these drugs include:
Excessive prescribing and use of prescription opioids is one major route that puts users on the path to developing opioid use disorder, the SAMHSA report says. As seen with other groups of users, some Black opioid users who become addicted to prescription opioids move on to heroin because it is cheaper and easier to find.
Prescription drug monitoring and protocols created to tighten up on overprescribing practices have reduced the availability of these drugs, making some drug users seek alternative ways to satisfy their drug cravings.
Black communities have a long history with cocaine, crack cocaine and heroin. These drugs are now more lethal as drug traffickers cut them with dangerous ingredients, including illegally manufactured fentanyl, which is 80 to 100 times more powerful than morphine. Fentanyl and fentanyl analogs are often mixed into illicit drugs without users knowing. This often leads to overdose deaths. If the user lives, they might become addicted to opioids.
Multi-Generational Drug Use
SAMHSA’s report highlights that using recreational drugs runs in some families, which is not unusual in some family circles. Many turn to selling drugs to make a living, and using the drugs is just a way of life. This kind of drug use can involve multiple substances, including opioids.
Codeine is one opioid that has been abused on the recreational scene, particularly in Black/African American communities. It is an ingredient in “Purple Drank” or “Sizzurp,” which is a mix of the opioid along with promethazine-based cough medicine and other ingredients, including soda and hard candies that sweeten up the drink.
What’s Next and How to Get There
It is widely recognized that it is challenging to get people into a treatment program, no matter what walk of life they are from. About 10 percent of people battling substance use disorders make it into treatment, data show. That means many people do not get the help they need for addiction, which is a medical issue, despite the stigma and negative stereotypes that remain. Those are slowly changing as the general public becomes more aware of what addiction is (and isn’t).
However, in the Black/African American community, getting people into treatment is difficult for these reasons and more. There is a fear of being incarcerated or put into the justice system based on how Black people have been treated for having a substance use disorder in the past.
More Education, Affordable Treatment Options
SAMHSA’s report suggests that education about OUD and SUDs is needed to help residents of minority communities understand what these disorders are and the options that can treat them. Sharing more information about how the treatment process works can help people who are reluctant to get involved with the medical system. They also need to understand that addiction treatment entails more than taking medication or going to detox.
Other strategies include connecting Black communities with affordable treatment options that ensure their access to evidence-based methods and medications that can treat their addiction. Supporters encourage making treatment access even for minority populations.
Culturally Responsive Treatment
Treatment that addresses the cultural needs of Black/African American communities is also important. A welcoming space can increase trust between addiction care providers and residents who live in these areas.
“Ensuring opioid education campaigns include Black/African Americans that are relatable to the intended audience is key to having an impact,” SAMHSA writes.