Verified by 
Over 130 Americans die each day from opioid overdose (OD). Opioid mortality rates have risen so high that they now exceed deaths due to automobile accidents and breast cancer. The federal government estimates that over 49,000 deaths involved opioids in 2017, an increase of over 500 percent since 1999. Despite longstanding concerns over these deaths in the U.S., the problem continues to worsen.
Almost every sociodemographic group has been affected by the current opioid crisis, but most of the attention has focused on white, middle class, rural, and suburban Americans. Though it’s true that at the start of the epidemic 20 years ago, surges in opioid deaths were not seen in Black communities, this is no longer the case. Recent data show that rates of opioid misuse and deaths among Blacks are fast approaching that of Whites. In fact, opioid deaths appear to be rising among Blacks faster than any racial group in the U.S.
These deaths have been largely overlooked in the media, and solutions that specifically focus on Black communities have been noticeably missing from political discourse. The opioid OD crisis has had detrimental effects on Black communities and the inattention paid to African-Americans is an important omission from the discussion. Policy and treatment interventions aimed at the general population tend to ignore the unique needs of many Blacks, especially those living in lower-income communities. A successful approach to address the opioid crisis will require a deeper understanding of Black Americans who use opioids.
A few recent articles have brought much needed attention to this problem. A piece published last year in the Journal of Law, Medicine & Ethics might provide the most comprehensive examination on the topic. These and other articles discuss issues ranging from the impact of stigma to the role that religion plays in Black communities. I’d like to briefly add three more thoughts to the discussion. Here are three things that should be kept in mind as we try to lower opioid-related problems in Black communities:
1. Providers are Not Prescribing Buprenorphine to Blacks
Buprenorphine is now the gold standard for treating opioid use disorders. Patients on buprenorphine are more likely to secure employment, avoid arrest, reduce risk of relapse and HIV, and improve overall quality of life. Most importantly though, use of buprenorphine can cut the risk of opioid OD by a staggering 50 percent. It is quite literally a lifesaver for many patients with opioid use disorder. But despite national efforts to make buprenorphine more accessible, very few Black patients are being prescribed buprenorphine.
In fact, a new study found that from 2012-2015, there was no increase in buprenorphine prescriptions written for Black Americans, and the results showed that Whites are almost 35 times more likely than Blacks to be prescribed the medication. It’s not entirely clear why this disparity exists, but one explanation is that Medicaid reimbursement rates are too small to attract prescribers to work in low-income Black communities. More research is needed to identify the root cause.
Nevertheless, something is very wrong with this picture. We have an ethical responsibility to ensure that access to effective treatments is equitable and not determined by a patient’s race or socioeconomic status. Providers and researchers need to take a closer look at why this life-saving medication rarely gets into the hands of Black patients. A significant increase of Black patients on buprenorphine should result in fewer deaths.
2. Overdose Prevention Centers Could Help Lower Black Opioid Deaths
Black opioid deaths tend to be concentrated in urban cities, where heroin (not prescription opioids) causes most deaths. In most of these cities, heroin is not only cheap and potent but is often laced with fentanyl. With Black opioid deaths mostly being caused by street-grade opioids, the national focus on lowering opioid prescribing has done little to address the crisis among Blacks.
An intervention, however, that has the potential to meaningfully lower the number of opioid deaths in Black communities is overdose prevention centers (sometimes called safe injection facilities). These programs offer people who are not ready/able to cease using drugs the opportunity to use substances under medical supervision. Trained staff are present to monitor for OD, test for fentanyl, administer naloxone if needed, and offer general medical advice, support, or referral to drug treatment.
Research shows that not only are these facilities effective at lowering deaths, but also at linking people to drug treatment and decreasing HIV infections. There are about 100 overdose prevention centers throughout Canada, Australia, and Europe, but no legally sanctioned sites are operational in the US. Overdose prevention centers have the potential to meaningfully lower opioid fatalities in Black communities because they are particularly adept at stopping fentanyl-related overdoses, the opioid most responsible for Black deaths.
3. Police Interventions Must Acknowledge the Drug War Legacy
For several decades, the U.S. has been waging their so-called War on Drugs. The primary tool the government has used to fight this war has been to incarcerate people who use drugs and sentence them to very long prison terms. By any measure, though, the War on Drugs has been an utter disappointment, resulting only in enormous prison populations, the decimation of families, and wasted resources, all the while failing to reduce rates of addiction and OD deaths.
But nowhere have the consequences of the Drug War been felt more than in poor Black communities. In fact, heavy-handed drug enforcement responses have become the norm in these communities since the inception of the drug war in the 1970s. And while there has definitely been a welcomed shift away from incarcerating people with substance use disorders, Blacks are still more likely to be arrested for their opioid use and are punished more severely than Whites. For example, Black Americans account for only 12 percent of drug users, but comprise almost 30 percent of drug arrests nationally. This legacy of over-enforcement has no doubt left serious scars on Black communities. Some of these scars likely make the use of police officers to address the epidemic in Black communities difficult.
Law enforcement agencies have recently launched initiatives that de-emphasize incarceration in favor of providing treatment to people with substance use disorders. Some of the more popular initiatives like PAARI (Police-Assisted Addiction and Recovery Initiative) and the Angel program have received national attention. What is important to remember here is that diversion programs like these stand in stark contrast to the aggressive tactics police have historically used in Black communities. It is unreasonable to think that residents of these historically over-policed neighborhoods would suddenly view police as sources of help and support. These programs need to be implemented in Black communities with this legacy in mind, perhaps offering specialized training to officers working in these neighborhoods. It is also incumbent on police departments to implement these treatment-oriented programs in Black communities with the same frequency and zeal with which incarceration was used during the height of the drug war.
