How Overdose Surged for Black People as It Held Steady for Whites

September 15, 2021

As opioid-involved overdose fatalities were holding steady for most racial groups prior to the COVID-19 pandemic, new research details how they were rising sharply for Black Americans.

In a study published on September 9 in the American Journal of Public Health, the overall fatality rate among Black Americans was shown to increase 38 percent between 2018 and 2019. Overdose among other groups showed no change. (During the pandemic, overdose deaths have risen across all groups.) 

Overall overdose increased slightly from 2018 to 2019—from 38.3 to 39.5 deaths per 100,000 people. Among Black people, it increased from 31.3 to 43.2.

The data included 67 communities in four states—Kentucky, Ohio, Massachusetts and New York—that are part of the HEALing Communities Study, a National Institutes of Health program analyzing overdose-prevention efforts around the country. The communities have a combined population of more than 8 million.

“The interventions we’ve invested heavily in, that we know work, are far from equitably distributed.”

In Kentucky, fatal overdose increased 46 percent for Black residents while declining slightly for white residents. In New York, it stayed the same for Black residents—but declined 18 percent for white residents.

“The interventions we’ve invested heavily in, that we know work to reduce opioid overdose, are far from equitably distributed,” lead author Dr. Marc R. Larochelle, an addiction specialist at Boston Medical Center, told Filter. “In particular, medications for opioid use disorder that are known to save lives, and overdose education and naloxone distribution.”

Larochelle also attributed the inequalities in overdose to differing routes of administration among some groups. “Injection opioid use is more common in white individuals,” he said. “Black individuals historically have used more cocaine, and through other routes of administration like intranasal or smoking.” Drug users who do not inject are less likely to visit syringe service programs, which can leave them even more vulnerable.

Cocaine-involved overdose deaths in the US tripled between 2013-2018. People who use stimulants often do not think of themselves as opioid users, and have neither the tolerance nor the Narcan for the fentanyl contaminating their supply because they aren’t expecting it to be there. 

A 2019 study showed that white Americans were 35 times more likely to see a doctor for buprenorphine than were Black Americans. Methadone access barriers are even higherpatients are at the mercy of their clinics, which are famously punitive and arbitrary. And anyone who sees you enter the clinic knows what you are there for.

Larochelle urged elected lawmakers to consider deregulating access to methadone, making it easier for patients to obtain. In New York, a bill awaiting Governor Hochul’s signature would prevent Medicaid from denying someone medication for opioid use disorder after their doctor has prescribed it.

“Another broad approach,” Larochelle said, is decriminalization, including possession of safe equipment to use drugs and “moving away from carceral approaches.”



Photograph via Tennessee Department of Mental Health & Substance Abuse Services

Alexander Lekhtman

Alexander is Filter's staff writer. He writes about the movement to end the War on Drugs. He grew up in New Jersey and swears it's actually alright. He's also a musician hoping to change the world through the power of ledger lines and legislation. Alexander was previously Filter's editorial fellow.

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