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New research shows racial inequalities in the rate of opioid overdose, with a mortality rate among blacks growing faster than in other groups. Researchers are calling for expanded access to drug treatment and education on how to prevent overdoses with the antidote drug, naloxone. Spencer Platt / Getty Images hides the title
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Spencer Platt / Getty Images
New research shows racial inequalities in the rate of opioid overdose, with a mortality rate among blacks growing faster than in other groups. Researchers are calling for expanded access to drug treatment and education on how to prevent overdoses with the antidote drug, naloxone.
Spencer Platt / Getty Images
A study published on Thursday reveals a growing racial disparity in opioid overdose mortality rates. Deaths among African Americans are growing faster than among whites across the country. The study’s authors call for an “anti-racist public health approach” to addressing the crisis of black communities.
The study, conducted in collaboration with the National Drug Abuse Institute of the National Institutes of Health, analyzed overdose data and death certificates from four states: Kentucky, Ohio, Massachusetts, and New York. He found that the rate of opioid deaths among blacks increased by 38% from 2018 to 2019, while the rates of other racial and ethnic groups did not increase.
The study used data collected before the coronavirus pandemic began; Preliminary data show that the global drug overdose increased in 2020.
According to another study published last year in the journal Addiction, African Americans had lower overdose death rates in the first waves of the opioid crisis than whites, and black rates remained the same from 1999 to 2012. No however, in 2013 white rates began to decline while black rates began to rise.
The new NIDA study confirms the trend.
“We’re seeing change in demographics,” says Dr. Nora Volkow, director of NIDA.
Dr. Edwin Chapman, an internal medicine and addiction medicine specialist who serves the African-American community in Washington, DC, says the study is useful because it shows the serious impact of opioid addiction on black Americans.
“It points to the fact that we need to do something different, a more intensive intervention in the African American community,” he says.
What is behind the disparity?
The change raises a number of pressing questions about what is driving the growing gap in addiction treatment and prevention and how it can be closed.
The opioid crisis began with the strong prescription of opioid analgesics, mainly in the white communities of the 1990s. Volkow says the crisis initially affected white Americans more because they are much more likely to be prescribed opioids than black Americans.
“This, in part, reflects on the stigma against blacks that even if they have pain, doctors won’t be as receptive to prescribing them as opioids,” Volkow says.
Structural differences in health care are also to blame for racial disparities in the treatment of addiction, Volkow says. These include access to effective evidence-based treatments.
“If you’re a black American and you have an opioid use disorder, you’re much less likely to be prescribed medications for opioid use disorder,” says Volkow, who notes that medications like buprenorphine have been very effective in protecting patients from overdose. “That’s discrimination,” Volkow says.
The increase in fentanyl, a potent synthetic opioid often found in heroin, has also affected overdose rates among blacks, she says. The main engine of overdose deaths has shifted “from prescription opioids then to heroin and now to fentanyl.”
Overdose deaths in black communities are largely caused by fentanyl.
Other factors are also at play in these mortality rates, Volkow says. It recognizes that the federal government and health care systems, such as hospitals, community clinics, and family physicians, need to put in place mechanisms to collect better data. Currently, many doctors do not detect opioid use disorder, Volkow says.
These data, she said, could “provide us with a better perspective of the nature of the problem and help or guide physicians in interventions.”
In the study, the authors noted that there are also disparities in access to the antidote drug, naloxone, and in training on how to use it to save a life.
Need for a true “public health response”
“It’s downtown communities that have been hardest hit by addiction, where the problem was put aside for four decades,” says Dr. Andrew Kolodny, medical director of opioid policy research at the Heller School for Social Policy and Management at Brandeis University. “It wasn’t until we saw a drug crisis affecting white communities that we began to see the resources of Congress.”
He says it’s important that addiction resources go to the communities that need them most.
“One of the problems here is that we have terrible surveillance of the opioid crisis,” Kolodny says. He notes that nationwide, tracking data on drug addiction has been a mosaic, with some federal agencies focusing exclusively on overdose deaths, others on treatment, and others on research. “Surveillance fell through the cracks,” he says.
For COVID-19, the U.S. tracks cases, deaths, and hospitalizations at the county level, and generally on a daily basis, Kolodny says. “But for the opioid crisis, we don’t have a good estimate of how many Americans are opioid addicts or the communities that have the most impacts or incidence rates. We don’t know how many people become opioid addicts.” says Kolodny. “We’re still in the dark era.”
“Opioid addiction is a disease that can be prevented and treated and you need a public health response that is similar even to an outbreak of a communicable disease like COVID.”
He says that in addition to overdose data by race, the U.S. should track demographics such as gender and age and whether those affected live in rural or urban areas. “We need data on which we can act. And that’s not here,” says Kolodny, referring to the new NIDA study, which calls it “far too little, too late.”
Improve access to treatment
Addiction specialist Edwin Chapman has worked his life to fight the drug epidemic in the black community. He says drug addiction in these communities has always been treated differently. “Whether it’s racism or cultural incompetence, we need to correct that,” he says.
NPR outlined Dr. Chapman’s work in 2018 when the opioid crisis began to escalate in urban black communities across the country.
Chapman knows all too well the problems facing the African American population when it comes to drug addiction and treatment, “starting with the fact that our epidemic was largely ignored, followed by insurance barriers and access to treatment, ”he says.
“Our population has always been treated as a moral and criminal problem, which means that the patients we treat in the African American community have this added burden,” he says.
From his experience at his clinic, he says he has found it more complex to treat black patients, as additional resources are needed, such as helping to navigate the health care system, advising and helping to find housing or a job.
Chapman says black communities also have a “provider access problem.” He notes that relatively few addiction treatment specialists focus their practice on treating black patients. “In addition, there is stigma within the provider community about the treatment of these patients because they are always perceived to have a criminal inclination or are not desirable as patients,” he says.
On the contrary, Chapman adds, “there is the shame and stigma that patients carry, so patients do not seek treatment.”
Chapman says the number of patients he is currently treating has decreased during the pandemic, “some died of COVID, others from overdose,” he says by early 2020, his clinic was seeing 270 patients, now the number of patients is 230.
The COVID-19 crisis increased overdose deaths in Washington, DC, according to the chief medical examiner’s office. In 2019, which was previously the highest peak, there were 281 overdose deaths, but in 2020 there were around 408, and there have been a total of 157 overdoses this year.
Finding solutions to these problems will not be easy, Chapman says. “What we need is what I call a Marshall Plan that is basically a cut and funded by taxpayers in this subset of high-risk, high-cost patients,” he says.
Ignoring the African American population will ultimately be more costly for the country, he says. It gives him renewed optimism to see a new focus on these disparities and he will continue to treat people and talk about how to solve the problem, he says.
[ad_2]Source: https://www.npr.org/sections/health-shots/2021/09/10/1035445899/black-opioid-overdose-deaths-increasing-faster-than-whites-study-finds [ad_2]
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