From 2019 to 2020, the Centers for Disease Control and Prevention (CDC), reported a notable rise in drug-related overdose deaths. The increase was particularly high among Black and Native American populations. The pandemic had a considerable and detrimental effect on the mental health of Americans. Increased drug use, most significantly of opioids, but also stimulants such as cocaine, was one consequence of this.
Disparities in drug overdose fatalities have always existed among different racial groups, but the recent trend has served only to widen the rift between different segments of the population. The representation of people of color has always been disproportionally high, with the white population less affected. The recent CDC report shows that this remains unchanged. In light of this, it is something of a paradox that White Americans have always been the ‘face’ of the opioid crisis as portrayed by the media. The marked rise in overdose victims among African Americans and Native peoples further highlights long-standing inequalities – in income, but also in access to substance abuse treatment, and the implementation of preventive measures. The worsening of drug use among these populations also stigmatizes them further.
Root Causes of this Racial Disparity
The figures speak for themselves and are eloquent. The CDC morbidity and mortality weekly report in question indicates that drug overdose fatalities rose by 30% in the US from 2019 to 2020. The increase among non-Hispanic Black Americans was an alarming 44%, and a similarly worrying 39% among American Indian persons and Native Alaskan peoples. This is not to say White Americans were not affected – their group still showed a major increase of 22%.
A common assumption that substance use habits and patterns are a major cause of higher overdose rates among the above racial groups turns out to be inaccurate. Inequality of living conditions is by far a greater contributing factor, beginning with income disparity. In counties with the greatest income inequality, overdose deaths in Black people were more than twice as high as in counties with less inequality. Low or irregular income often leads to unstable housing situations, lack of health insurance, and unreliable transportation. As a result, sufferers of drug abuse have reduced access to mental health care and addiction treatment. This includes the availability to them of medications such as buprenorphine, a potentially life-saving treatment for opioid addiction.
Native American and Alaskan communities are often underfunded. They lack the budget to put in place effective preventive measures and strategies to raise people’s awareness – both of the dangers of their drug use, and ways to get help.
Tragically, young people are shown to have been the most affected, across all racial communities, particularly the 15 – 24 age group. But the discrepancies remain the same. The increase in overdose deaths among Black youths was a staggering 86%, and even among young White Americans, reached 34%. Senior citizens were also badly hit, with Black male victims over the age of 65 seven times more numerous than white ones.
Inadequate access to emergency services is another contributing factor. Although full three-quarters of overdose deaths in the above period were opioid-related, the life-saving drug Naloxone, which can reverse the effects of opioid overdose, was only administered in less than a fifth of cases.
Direct Influence of the Pandemic
The pandemic changed both the habits of drug users (increased use) and the way drug dealers operate. The presence of the illegal and synthetic opiate fentanyl saw a marked rise. Since small amounts of fentanyl cause very powerful effects, the drug seems to have been easier to circulate for traffickers than shipments of other opioids. Fentanyl can easily cause death by overdose when taken alone, but it is often used in combination with stimulants, notably methamphetamine or cocaine. Polydrug abuse is one of the main causes of drug-related fatalities.
Illicitly manufactured fentanyl is also increasingly contaminating other drugs. Dealers ‘cut’ them by adding some of the potent substance for greater effect. As a result, many drug users have no idea they are consuming such a dangerous cocktail of chemicals – nor even, perhaps, many ideas of what they are using at all.
The pandemic caused a great many people to start using their substances of choice in isolation. As a result, there was nobody around to call for help or sound the alarm when they began to present symptoms of overdose. In the case of opioid overdoses reported, bystanders were only present in less than half of the cases.
Remedial Measures
Turning the tide on the increase in overdose deaths requires considerable focus on preventive measures. Better access to treatment services for the most vulnerable is essential. While most overdose victims in the report had a history of previous substance abuse, few had ever received treatment for their condition – only 1 in 12 people among Black Americans. Wider distribution of fentanyl strips – which allow users to know if their drugs contain it – would help too. Research into medication-assisted treatments for addiction to stimulants needs to progress. And, both Naloxone and buprenorphine need to be more widely circulated to clinics in vulnerable areas.
At-risk groups would benefit from more information. Many are unaware their drugs may contain fentanyl. Since TV and media coverage of the opioid epidemic – declared a national emergency in 2017 – has always focused on White Americans, many individuals from other segments of the population are unaware they are caught up in the crisis too. Discrimination, both racial and social, is partly to blame for this. Now that White Americans are proportionally less affected, the gravity of the drug crisis is less broadcasted.
It is a sad fact, too, that treatment bias remains a reality – the treatment available to patients continues to be impacted by their social class or background, which, needless to say, goes against the Hippocratic Oath. The road to equality may be long. However, the CDC report sheds precious light on precise facts, and on what needs to be done.
