Changing Faces: How the Opioid Epidemic is Sweeping Across Urban Minority Communities in the U.S.
By: Jasmine Drake, Ph.D. & Jennifer Wyatt Bourgeois, M.S.
The current face of the opioid epidemic in America has been one considered to primarily plague rural and suburban communities with White, Non-Hispanics overwhelmingly suffering its devastating effects. According to the Centers for Disease Control (CDC), from 1999 to 2016 in the United States, White, Non-Hispanics experienced the highest rates of opioid overdose deaths amongst any ethnic group. Their age-adjusted rates (used to make fairer comparisons between groups with different age distributions) of overdoses increased by over six-fold during this timeframe.
Source: Kaiser Family Foundation analysis of Centers for Disease Control and Prevention (CDC), National Center for Health Statistics. Accessed at http://wonder.cdc.gov/mcd-icd10.html
However, in recent years, there has been a historic surge in the number of opioid overdose deaths sweeping across urban, minority communities in the United States, but their stories are often not addressed in the narrative for tackling this alarming epidemic. According to the CDC, over the past 17 years, age-adjusted opioid related deaths for Hispanics have climbed from 3.5 overdoses per 100,000 in 1999 to 6.1 overdoses per 100,000 in 2016. More significant increases have been reported for Blacks during the same 17-year timeframe with age-adjusted rates of 3.5 overdoses per population of 100,000 in 1999 to 10.3 overdoses per population of 100,000 in 2016. In February, the Surgeon General tweeted
And in 2016, Black & African American youth 12-17 were more likely than whites to have used opioids in the past year. This data shows that we are moving in the wrong direction, & may be a precursor to even more opioid overdose fatalities in the black community in coming years.
This growing trend is evident in the figure below, which provides 2016 data for the States leading the nation with the highest reported numbers of opioid overdose deaths for minority groups by ethnicity. In comparison to the U.S. national average of opioid related deaths in 2016, the opioid epidemic was found to disproportionately impact Blacks with them leading the number of opioid overdoses in the District of Columbia, Illinois, Missouri, Wisconsin and West Virginia. Interestingly, in West Virginia, which leads the nation in opioid overdoses at a rate of 44.3 deaths per 100,000 for Whites, Black, Non-Hispanics experienced more opioid overdoses (46.5 deaths per 100,000) than any other ethnic group.
Source: Kaiser Family Foundation analysis of Centers for Disease Control and Prevention (CDC), National Center for Health Statistics. Accessed at http://wonder.cdc.gov/mcd-icd10.html.
Note: Specific ethnicity-based data were not available or reported for all States.
As a point of reference, the 2016 opioid overdose rates for Texas, which has remained below the national average across all ethnicities and has the third lowest death rate in the country, has been provided. The low numbers of opioid related overdoses in Texas when compared to the national average may give the impression that there is no real threat of an opioid epidemic in the state. Although Texas is far below the national average of opioid overdoses, these drugs have severely impacted rural areas in Texas, such as in Baylor County, where there was a reported 30 opioid related deaths per 100,000 population in 2016, according to the Texas Health Institute. Additionally, from 1999 to 2016, Texas saw a 3.6 fold increase in opioid overdose deaths for Blacks, Non-Hispanics, a 3.8 fold increase for Hispanics, and a 3.9 fold increase for White, Non-Hispanics, according to a recent report.
Previous research has suggested that the increasing threat of the opioid epidemic’s impact on urban, minority communities may be attributed to several factors, such as the under-prescribing of prescription opioids to minorities, the availability of potent new non-methadone synthetic opioids, and the lack of evidence-based treatment solutions. Disparities in the under-prescribing of prescription opioids in minority communities was once thought to shield these communities from the devastating effects of the opioid epidemic. However, several studies have suggested that this racial disparity in the under-prescribing of prescription medications in urban communities may cause minorities to access illicit preparations of these drugs, which are often laced with potent synthetic opioids, such as fentanyl. In recent years, many urban communities have experienced a significant spike in the number of opioid overdoses, which may be linked to the availability of synthetic opioids, such as fentanyl or carfentanil. These potent synthetic opioids, which are roughly over 100 times more potent than morphine, are lethal at very low levels and are often used as cutting agents in illicit drugs, such as heroin and cocaine. It has also been suggested that the addition of these potent synthetic opioids to street drugs and counterfeit pill preparations that are available on the black market may also be linked to the increased rates of overdoses over recent years in minority communities. For instance, according to CDC data, the reported number of Cocaine overdoses for blacks doubled from 1.6 per population of 100,000 in 2003 to 3.2 per population of 100,000 in 2016.
According to the previous research, there is also a lack of evidence-based solutions and policies for addressing the opioid abuse problem in urban, minority communities. Although the opioid epidemic has been declared a new emerging threat, it has striking resemblances to the heroin and crack cocaine epidemics, which plagued urban, minority communities in the 1970’s and 1980’s. Akin to the opioid epidemic that has greatly impacted middle-class White, Non-Hispanics in rural and suburban communities in recent years, these epidemics had lasting and devastating effects in urban, minority communities. The U.S. Government’s “War on Drugs” and criminalization of drug offenses during these eras led to the mass incarceration of blacks. According to the Bureau of Statistics, in 2016, though Blacks made up only 12 % of the U.S. population, they comprised over 33% of those incarcerated in the criminal justice system. There have been similar devastating effects in the Hispanic communities. A report by the Drug Policy Alliance, states that although Hispanics make up approximately 17 % of the U.S. population, they make up 50% of all Federal Drug cases. According to Michelle Alexander, who authored The New Jim Crow: Mass Incarceration in the Age of Colorblindness (2010), “nothing has contributed more to the systematic mass incarceration of people of color in the United States than the War on Drugs.” Due to the traditional criminal justice response to substance abuse in urban communities, minorities may also be more unlikely to seek rehabilitative treatments out of their fear of incarceration.
As a result, the complexities of the urban community’s strained relationship with the criminal justice system has to be considered when creating culturally sensitive solutions for addressing the opioid problem in these communities. Socioeconomic factors, such as disparities in access to affordable healthcare, that may also create barriers for minorities seeking help from rehabilitative treatment facilities must also be considered. In order to effectively assess and mitigate the devastating effects of the opioid epidemic in minority communities, there is a need to create evidence-based policies which take into account the unique cultural experiences of these populations. These policies should focus on key issues and culturally sensitive solutions to coping with this epidemic, such as exploring minority relations with the criminal justice system, increasing the availability of faith-based rehabilitative treatment alternatives, and the availability of low-cost rehabilitative treatment facilities.
Jennifer Wyatt Bourgeois
Graduate Research Fellow, Center for Justice Research at Texas Southern University
Jennifer Wyatt Bourgeois is a doctoral student in the Department of the Administration of Justice in the Barbara Jordan – Mickey Leland School of Public Affairs and graduate research fellow in the Center for Justice Research at Texas Southern University.
Jasmine Drake, PhD
Research Fellow at the Center for Justice Research at Texas Southern University
Jasmine Drake is a research fellow in the Center for Justice Research and assistant professor with the Department of the Administration of Justice in the Barbara Jordan – Mickey Leland School of Public Affairs at Texas Southern University.