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Researchers Call for Antiracist Approach to Address Disparities In Overdose Deaths

A man volunteers for Prevention Point Philadelphia and Step Up to the Plate in the Kensington neighborhood on July 19, 2021 in Philadelphia, Pennsylvania.

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Key Takeaways

  • A pre-pandemic study found a 38% increase in overdose deaths among non-Hispanic Black people between 2018 and 2019 in four states including Kentucky, New York, Ohio, and Massachusetts.
  • Researchers say an antiracist public health approach is needed to address the opioid overdose epidemic.
  • The data has helped communities focus more intentionally on reducing inequities.

Opioid overdose deaths have risen disproportionately in Black communities in recent years, according to a new study. Researchers say the findings highlight health disparities that have existed before the pandemic and the need for an antiracist public health approach.

“The pandemic really just set fire to all of the underlying disparities in all areas of health, in particular addiction,” Marc LaRochelle, MD, MPH, a physician at the Boston Medical Center and co-leader of the study, tells Verywell. “These trends were not only driven by it, they were emerging before the pandemic.”

The research found that overdoses increased about 38% more among Black individuals than Whites from 2018 to 2019 in four states: Kentucky, Ohio, Massachusetts, and New York.

When separating the state-by-state data, increases in overdoses among Black people were highest in Kentucky, at a 46% increase. In New York, the trends among Black individuals remained stable while overdose rates among White individuals declined over the same period by 18%, again showing a racial disparity in outcomes.

The findings are part of the largest addiction study ever conducted, the HEALing Communities Study, which investigates how effective certain prevention and treatment methods are in 67 local communities within those states. Led by the National Institute of Health (NIH) and the National Institute of Drug Abuse (NIDA), the study aims to reduce opioid overdose deaths by 40% in three years in the designated communities.

Researching racial disparities in overdoses was a topic requested by the communities in the study, LaRochelle says. He adds that he had expected to see discouraging results, but was surprised by how dramatic the outcomes proved to be.

NIDA Director Nora Volkow, MD says that the increasing prevalence of heroin and synthetic opioids like fentanyl play a role in rising overdose deaths in Black people. This marks a shift from the beginning of the opioid overdose epidemic, when more White people were dying, she says.

Between 1999 and 2016, prescription opioids accounted for more overdose deaths than heroin. Because of racial discrimination in health care, doctors often prescribed fewer of these medications for Black people even when necessary, Volkow says. But as opioids entered the illegal market, they became accessible to wider groups of people—and more lethal when combined with synthetic concoctions.

“The drug that they had used in the past, more safely, is now very, very risky,” Volkow tells Verywell.

Prejudice, stigma, and distrust can likewise bar people of color from seeking medication-assisted treatment for opioid use disorder, LaRochelle adds. People may be hesitant to seek help if they’re afraid of criminal consequences due to historical and current repercussions of the war on drugs.

“Our shift to really focusing on treatment and compassion towards people who use drugs really emerged in the last 15 to 20 years when death started accelerating among White people,” LaRochelle says. “There’s a lot of underlying structural issues and inherently racist policies that have led to some of these changes, we’re now bearing fruit in terms of these really terrible emerging disparities.”

The study findings have implications outside of the research world, LaRochelle says. They can be used to guide communities in better tailoring their healthcare interventions for underserved groups. 

He and his team shared their research with the HEALing communities more than a year before it was published, in summer 2020, so that they could incorporate the data into their outreach efforts as soon as possible. The groups were able to more confidently determine gaps in their system and focus more intentionally on reducing inequities, LaRochelle adds.

“It's led to a much more explicit commitment to equity in terms of how we deploy resources,” he says.

Currently, the HEAL team is testing out approaches such as bringing vans with harm reduction tools like fentanyl test strips, medication-assisted treatments, and overdose training resources into impacted communities. Having bilingual outreach workers who can speak to people in their local language is another important part of this approach.

“Every community is different in what they have access to, and what's there, and what they know about the people, and what will work better,” LaRochelle says. “This is far from a one-size-fits-all solution. Every community's approaching things in a tailored way.”

What This Means For You

Regardless of whether you're experiencing opioid use disorder, you can practice overdose prevention methods like carrying Narcan with you or taking an overdose training. Pharmacies in most states offer Narcan to people over-the-counter.

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  1. Larochelle MR, Slavova S, Root ED, et al. Disparities in opioid overdose death trends by race/ethnicity, 2018–2019, from the healing communities studyAm J Public Health. Published online September 9, 2021:e1-e4. doi:10.2105/AJPH.2021.306431

  2. National Institute on Drug Abuse. Overdose Death Rates. Updated January 29, 2021.