Optimistic headlines point to a decline in overdose deaths, suggesting we have turned the corner on the opioid crisis and hope is on the horizon. At the same time, in “the opioid epidemic nobody talks about,” overdose deaths are rapidly increasing in many Black communities. Who is paying attention? More importantly, who is taking action?
What the data says: Opioids are not just about white people
Drug addiction has devastated Black communities for decades, and in recent years, the national opioid overdose death rate has been increasing more quickly among Black populations than among white ones. From 2016-2017, the mortality rate among Black, non-Hispanic individuals rose by 25 percent, compared to the 11 percent increase among white, non-Hispanic individuals. The increase among Latinx people just outpaced the rate for white people at 11.5 percent, emphasizing the crisis is not limited to white populations.
At the state level, 2017 opioid overdose death rates were actually higher for Black, non-Hispanic individuals than for white individuals in Illinois, Iowa, Michigan, Minnesota, Missouri, Washington, West Virginia (often called the “epicenter” of the opioid crisis), Wisconsin and the District of Columbia (see Figure 1). In Washington state, the drug and opioid-involved overdose death rate for American Indians and Alaska Natives also far surpasses that of White individuals.
The problem: Black communities are left behind
Centering public attention and policy about the opioid crisis on white Americans provides yet another example of how structural and systemic racism permeates our responses to addiction. It reinforces the historic framing that white people need treatment while Black people deserve criminal punishment. Ignoring how substance use disorders hurt Black communities and other non-white racial and ethnic groups perpetuates the idea that they do not matter and their health, lives and voices are not important.
Moreover, the benefits of the public health response to promote treatment rather than incarceration have not reached these groups most in need. Chicago ranked lowest across the Midwest in capacity for medication-assisted treatment, an essential part of addiction treatment. For years, we’ve seen research demonstrating that the unmet need for addiction treatment is worse for African-American and Latinx populations compared to white. This comes as no surprise given race-based health disparities across the health system.
Despite recent legislative successes meant to curb overdoses, policymakers cannot assume efforts will automatically reach everybody in need. The structural racism in this country runs too deep.
What we need: An anti-racist approach
Opioid related deaths in white communities are devastating. Continuing to elevate their pain over other races and ethnicities, however, will only worsen health disparities, jeopardizing the lives of people of color. This country requires an anti-racist agenda to truly ensure progress and improve health outcomes for everyone.
The Chicago Urban League’s Issue Brief, Whitewashed: The African American Opioid Epidemic, highlights three principles to guide opioid policy to ensure Black communities are not left behind: 1) Black voices cannot be excluded from the opioid narrative, 2) Black leaders and organizations must be involved in all stages of public health policy development and implementation, and 3) Health programs must meet the needs of Black communities, including removing current and historic barriers to health.
We also recommend:
- Expanded access to addiction treatment in Black communities and other historically oppressed groups;
- Increased funding for treatment and wrap-around services for all substance use disorders, not just opioids. Opioids are not always the leading problem: Opioids are responsible for a staggering 91 percent of drug overdose deaths in New Hampshire, but 26 percent in Hawaii. National numbers show methamphetamine-related hospitalizations are soaring;
- Racial impact statements for drug addiction treatment, services, prevention and enforcement policy, similar to those in some states for sentencing, parole or probation policy;*
- Increased opportunities for faith-based organizations to provide prevention services and treatment;*
- In addition to “culturally competent” substance use disorders services and treatment programs, an anti-racist framework to specifically address the needs of people of color seeking services within a health system and society where structural racism exists;*
- And supporting the long-standing efforts of groups such as The Urban Minority Alcoholism and Drug Abuse Outreach Program of Franklin County (UMADAOPFC) that provide services specifically for the African-American community.
In the words of my former colleague, “Any strategy that doesn’t see people of color as essential to the fight also guarantees that even when there is a win – people of color continue to lose.”
Source: Adapted from Kaiser Family Foundation Opioid Overdose Deaths by Race/Ethnicity, 2017. Available here.
*Also highlighted in The Opioid Crisis in Black Communities