Drug overdose deaths among Black Americans increased by record numbers in 2020, a new study finds. Some recent deaths include Juice WRLD, Shock G, and DMX, household names we already know. But to the unknown names of Black folks who’ve overdosed, they are more than a statistic — they are our family and neighbors.
Scientists say pressures from the COVID-19 pandemic, accessibility to treatment, and stigma contributed to an overall rise in overdose death rates.
Illicitly manufactured drugs like fentanyl have increased in drug supply and have driven up drug overdose deaths in recent years, scientists from the Center for Disease Control and Prevention have found.
But no other community has been hit as hard by the fentanyl crisis as the Black community, a new study shows.
Mbabazi Kariisa, a health scientist co-authored a study of drug overdose deaths in marginalized communities in 25 states and the District of Columbia. Drug overdose deaths increased 30% in the U.S from 2019 to 2020, but the CDC found that the death rate for those in the Black community increased by 44% in the same two years.
The striking increase in death rates has multiple contributing factors, many of them Kariisa says can be improved.
“I want to stress that these drug overdoses are preventable,” she says.
Black young adults between the ages of 15-24 saw the highest increase in opioid overdose deaths compared to any other racial group. Fentanyl is already a powerful, very potent drug Kariisa says, but escalating the issue is the drug being mixed with cocaine and methamphetamine.
Historically, overdose death rates among older Black men tend to be higher Kariisa says. The study found the death rate for Black men between the ages of 45-64 increased by 33% while white deaths in the same age group increased by 23% despite white people overall having higher numbers of opioid use.
But overdose death rates are not only increasing for older Black men.
“Although they are the group that’s historically been the most effected, it is trending upwards for other socio demographic groups as well within the black community,” Kariisa says. “It is increasing for women and it’s increasing also for younger black people.”
Available Drug Treatment Services Aren’t Always Accessible
Another shocking discovery was a look at the number of available services in contrast with the death rates. Scientists looked at the number of opioid treatment programs at the county level, the rate of mental health providers at the county level, and the capacity for treating patients with substance use disorder.
“We found that generally as there was more, sort of, availability for treating substance use disorders or mental health disorders, there was also higher overdose death rates,” Kariisa says.
Meaning, the more services available to people struggling with substance use, the higher the overdose death rates — a surprising find, but Karissa says multiple factors may play a role in this.
For starters, Kariisa says a lot of these services are not distributed equally across the country. And, many of these services are based in more densely populated areas, where drug use and overdose death rates are more likely.
‘We know that just because [there are] services available [that] does not mean it’s accessible,” she said.
When asked what improving accessibility looks like, Kariisa says it involves several things like lowering costs of transportation so individuals seeking treatment can afford to get to their appointments, offering telehealth appointments so people do not have to travel long distances to get to their provider, and offering structural support like housing and childcare assistance.
“There’s ways to get around some of the access barriers,” she says. “It involves essentially tailoring our programs or efforts around the community specifically to help meet them where they are.”
Racial Disparities & Stigmas Keep Black People From Life-Saving Treatment
Two commonly used drugs to treat opioid use disorders include buprenorphine and methadone but the drugs are often associated with additional barriers. Prior to the pandemic, medical professionals required in-clinic visits for methadone use which created a barrier for some patients — now individuals can take this treatment at home.
“Historically there’s been racial disparities when it comes to accessibility of buprenorphine,” Kariisa said. “It has been more commonly available for white patients than for Black patients.”
Buprenorphine is a take-home drug prescribed as a replacement in the treatment of heroin and methadone dependence — in 2015 the average cost for the prescribed treatment was $32. But with more than 31 million people (about the population of California) are without health insurance in the U.S, affordability of the drug can range from $0 to $83.11 Kariisa says.
“If people are not insured, their out-of-pocket costs could be different than somebody who has insurance,” she says.
Naloxone or Narcan is a medication that reverses an opioid overdose for 30 to 90 minutes, but Kariisa says access needs to be increased. Currently, only some states offer Narcan for free and some health insurance plans will provide it with a $0 copay.
On top of that, opioid use stigma and general mistrust of the health care system in marginalized communities is an added layer to the issue, Kariisa says.
The stigmatization of opioid users in part comes from healthcare providers who sometimes expel individuals with withdrawal symptoms from emergency rooms assuming they are only seeking drugs. Individuals struggling with addiction may internalize this stigma, feel shame, refuse to seek treatment and have a mistrust of the health care system.
Stigma during COVID-19 can also come from bystanders and first responders who have a legitimate fear of contagion but may be reluctant to administer naloxone to people who have overdosed, according to the National Institute on Drug Abuse.
Addressing stigma is important to make sure individuals feel comfortable getting help when they need help, Kariisa says. A key part includes those in the community helping to bridge the gap by talking to opioid users in a non-judgmental and more supportive way, offering resources, and finding ways to help them get treatment.
The solution to this does not only fall on healthcare providers, Kariisa says, it is going to take a multi-sectoral approach; including politicians, policymakers, public health professionals, and community members.
“Using things like spirituality and religion, when appropriate, in combination with proven substance use disorder treatments is really key here,” she says. “And reducing the criminalization of substance use disorders can be helpful as well as offering support groups and community connections to help reduce stigma and mistrust.”
Scientists, medical professionals and community members know what works to treat opioid use addiction Kariisa said, but its dependent on improving access to treatment to decrease the opioid overdose death rates across the country.
“This is a mental health condition. It’s not a moral failing and it is it should be treated as such.”