The decades-long U.S. opioid epidemic could be hitting Black people harder than white folks as the crisis enters a new phase.
Opioid overdose death rates among Black Americans jumped nearly 40% from 2018 to 2019 in four states hammered by the epidemic, researchers found.
Fatal ODs among all other races and ethnicities remained about the same during that time.
This represents a significant shift in the opioid crisis, which in the early 2000s largely affected white people in rural areas, said lead researcher Dr. Marc Larochelle, an assistant professor at Boston University School of Medicine.
"Since 2010, we now recognize what people call the 'triple wave' of the opioid epidemic," he said. "The first wave was prescription opioid analgesics, and then 2010 to 2013, increases were largely driven by heroin, and from 2013, it's been illicit fentanyl infiltrating the drug supply."
Racial inequities in U.S. health care and social services are a likely reason for the continued increase in OD deaths among Black Americans, even as deaths among other ethnic groups have leveled out, said Larochelle and Dr. Kenneth Stoller, director of the Johns Hopkins Broadway Center for Addiction in Baltimore, who reviewed the study findings.
The spread of the powerful opioid fentanyl throughout the nation's illegal drug market has also probably played a role, both added.
"Cocaine and methamphetamine are increasing tainted with fentanyl," Stoller said. "These other drugs are causing overdoses in people who aren't used to using opioids, whose bodies aren't tolerant to those opioid drugs."
Larochelle's team gathered data for this study as part of the Helping to End Addiction Long-Term Communities Study, a federally funded effort to stem OD deaths in 67 communities hard-hit by the opioid crisis.
Those communities are in Kentucky, Massachusetts, New York and Ohio. The project has "a goal of reducing opioid overdose deaths by 40% in three years," Larochelle said.
Overall, opioid OD death rates were flat in the targeted communities between 2018 and 2019, researchers reported Sept. 9 in the American Journal of Public Health.
But looking more closely, researchers found a 38% increase in opioid overdose deaths among Black people.
Actions that have helped reduce the flood of OD deaths among other racial and ethnic groups don't appear to be having the same impact on Black Americans, Larochelle said.
He noted that laws have been passed to curb the illicit use of prescription opioid painkillers; communities have been educated on ways to treat overdoses and armed with the OD reversal drug naloxone, and medications have been made more widely available to treat people addicted to opioids.
"Unfortunately, they've been delivered in ways mirroring structural inequalities throughout our health care and public health systems," with the benefits mainly going to white people, Larochelle said.
Other matters that hamper Black Americans' access to health care likely play a role here as well, Stoller added. These include a lack of access to health care and affordable health insurance, no available child care, problems finding transportation to and from treatment, as well as homelessness.
"These are all just some of a host of other barriers that can limit the effectiveness of what we're trying to do to make a dent" in opioid OD deaths among Black Americans, Stoller said.
"Substance use disorders are very complex, in terms of how they're formed and sustained," he added. "We need to address the sustaining factors that limit treatment access and treatment effectiveness for Black people."
Fentanyl also could be contributing to OD deaths among Black Americans, through contamination of other illicit recreational drugs, Larochelle and Stoller said.
"What we're starting to see is concerning emergence of fentanyl-contaminated stimulants -- for example, someone who is intending to use cocaine and that cocaine is tainted with fentanyl," Larochelle said. "For a person who does not use opioids who is exposed to even small amounts of fentanyl, it can lead to an overdose unexpectedly."
He added that those are not the people who typically have been targeted for opioid harm reduction efforts because they're not intending to use opioids.
The numbers for this study were gathered prior to the COVID-19 pandemic, which caused drug use and OD rates to start rising again among all race and ethnic groups, Larochelle noted.
That means Black Americans might be even more at risk from opioid OD today than they were before the pandemic.
"The trends in this paper are actually pre-pandemic, but the pandemic has certainly exacerbated the crisis of overdose," Larochelle said. "Unfortunately, overall levels of overdose in the population have picked up again in the setting of the pandemic."
The U.S. Department of Health and Human Services has more on the U.S. opioid epidemic.
SOURCES: Marc Larochelle, MD, MPH, general internal medicine physician, Boston Medical Center, and assistant professor, medicine, Boston University School of Medicine; Kenneth Stoller, MD, director, Johns Hopkins Broadway Center for Addiction, Baltimore; American Journal of Public Health, Sept. 9, 2021