As COVID-19 consumed the U.S. in 2020, another health crisis was also raging: the drug overdose epidemic. Nearly 92,000 people died from drug overdoses that year, a 30% increase from 2019.
While overdose deaths rose across the population, the increase in deaths was far steeper among Black, American Indian, and Alaska Native people, according to data published July 19 in the U.S. Centers for Disease Control and Prevention (CDC)’s Morbidity and Mortality Weekly Report. Overdose deaths rose 44% among Black people from 2019 to 2020, and 39% among American Indian and Alaska Native persons, according to the CDC’s analysis of data from 25 states and the District of Columbia. For white Americans, they rose 22%.
Drug-related deaths have always varied by race and ethnicity, but the new data suggest that the rifts are deepening, and people of color are disproportionately affected. In the 1990s, when opioids surged, white people were more at risk of dying from drug overdoses than Black Americans, but deaths among Black people have more than caught up over the last decade. Overdose deaths among Black people have risen more than they have among white people every year since 2012, and rates of overdose deaths among Black Americans surpassed those for white Americans in 2020, according to a March analysis published in JAMA Psychiatry. Among American Indian and Alaska Natives, who historically had comparable overdose rates to white Americans, the rate of overdose deaths passed that of white people in 2019.
The authors of the recent study point to a number of root causes for the disparity, including unequal access to health care and effective treatments for substance-use disorder like buprenorphine, as well as the effects of income inequality, like unstable housing, worse insurance coverage, and unreliable transportation. Black, American Indian, and Alaska Native people who died were much less likely to have received substance treatment than white people, the authors noted: about 8.3% of Black Americans and 10.7% of American Indians and Alaska Natives had received treatment, compared to 16.4% of white people.
Many American Indian and Alaska Native communities have insufficient resources to treat substance-use disorder, and in many cases, people living on tribal reservations need to travel a long way to receive treatment, says Jerreed Ivanich, an assistant professor in the Colorado School of Public Health at the University of Colorado Anschutz and a member of the Metlakatla Indian Community (who was not involved with the new research). “You’re driving an hour, two hours plus, to get resources,” says Ivanich. “And if you don’t have a job, if you don’t have childcare, if you don’t have support networks at home, getting to those programs and resources becomes really difficult.”
A billboard, part of an awareness campaign to combat prescription opioid abuse in the Native community, stands along a road on the White Earth reservation in Naytahwaush, Minn., Thursday, Nov. 18, 2021.
The researchers note that fentanyl, a highly potent opioid that has contaminated the illicit drug supply and is sometimes used alongside stimulants like cocaine and methamphetamine, has also been driving a growing number of overdose deaths among Black Americans, American Indians, and Alaska Natives. More overdoses have involved both opioids and stimulants, such as cocaine or methamphetamine. Research from the CDC published in Drug and Alcohol Dependence in 2021 found that deaths involving stimulants combined with opioids are most common among American Indian and Alaska Natives, while deaths involving cocaine and opioids are most common among Black people.
“It is critical for prevention efforts to address fentanyl and polysubstance use, and work to reduce historical health inequities,” said Dr. Debra E. Houry, acting principal deputy director of the CDC, in a July 20 press briefing.
The pandemic accelerated drug overdose deaths both by disrupting the drug market and the lives of people who use drugs. As drugs became harder to move during the pandemic, traffickers seem to have increased their transport of fentanyl, which is less bulky. The pandemic also worsened people’s mental health and isolated them, which may have pushed people who use drugs to take them alone—which experts warn makes it harder for people to receive help from others, in the form of the overdose reversal drug naloxone or by calling an ambulance.
Even though research continues to find that people of color are most at risk for overdose deaths, white Americans are still the face of the drug overdose crisis in both media coverage and the medical community, says Dr. Ayana Jordan, a professor of psychiatry at New York University Grossman School of Medicine who researches treatment for substance-use disorders among marginalized communities (and was not involved in the new research). “When I give talks all over the nation, people are still surprised to know that Black people are outpacing the rate of white people in terms of opioid-involved overdose deaths.” And as white people have become less affected than Black Americans, attention has waned, she says.
“Ten years ago, you could not turn on the TV and not hear about the opioid crisis, and how it was affecting white people, especially in middle America. You could not escape it,” says Jordan. “With that same intensity, we need to say that drug overdoses are being fueled in Black and Indigenous communities at rates we’ve never seen before.”
That lack of attention can have public-health ramifications. Since neither Black people nor stimulant users have traditionally been the face of the overdose crisis, many people of color don’t know that they should be taking extra precautions, such as testing their drugs with fentanyl test strips. Black people also aren’t screened for opioid-use disorder often enough, she says. “A lot of people don’t even realize that fentanyl is indeed an opioid,” says Jordan. “I’ve talked to so many people who were like, ‘Oh, Dr. Jordan, I had no idea I was part of this opioid crisis.’”
There’s also an urgent need to develop medication-assisted treatment for addiction to stimulants like cocaine, Jordan says. Building awareness among scientists, clinicians, and the general public that Black and Indigenous people are so vulnerable to overdoses is necessary, she says, in order to save their lives.
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