Cultural, systemic and historical factors have converged to create the perfect storm when it comes to Black overdose deaths.<\/p>\n
\u00a0\u00a0\u00a0\u00a0\u00a0 By Liz Tung<\/a> – June 14, 2024 Reporter at The Pulse<\/strong><\/p>\n In this Jan. 23, 2018 photo, Leah Hill, a behavioral health fellow with the Baltimore City Health Department, displays a sample of Narcan nasal spray in Baltimore. The overdose-reversal drug is a critical tool to easing America\u2019s coast-to-coast opioid epidemic. (AP Photo\/Patrick Semansky)<\/p>\n From Philly and the Pa. suburbs to South Jersey and Delaware, what would you like WHYY News to cover?\u00a0Let us know!<\/a><\/em><\/p>\n A\u00a0recent study<\/a>\u00a0from the Pennsylvania Department of Health has found that Black people who died from opioid overdoses were half as likely as white people to receive the life-saving drug\u00a0naloxone<\/a>, otherwise known as Narcan. The study also found that Black overdose deaths in Pennsylvania increased by more than 50% between 2019 and 2021, compared with no change in white overdose deaths.<\/p>\n In an email, a representative with the Department of Health said that similar rises in\u00a0overdose deaths<\/a>\u00a0are being seen across the country, especially among Black, American Indian and Alaska Native populations. But researchers are still investigating what\u2019s behind the spike.<\/p>\n \u201cThere does not appear to be a single reason why rates are increasing for Black populations and holding steady among white populations,\u201d the statement reads. \u201cThe volatile and rapidly changing drug supply certainly has been a challenge as\u00a0fentanyl<\/a>\u00a0is now found in every type of drug. Inequities in terms of\u00a0treatment for substance use disorder<\/a>\u00a0may also play a factor as white people are more likely to have better access to the most evidence-based treatments and are more likely to stay in treatment.\u201d<\/p>\n Abenaa Jones, an epidemiologist and assistant professor of human development and family studies at Penn State who was not involved in the study, has conducted\u00a0similar research<\/a>\u00a0in Baltimore. She agreed that\u00a0fentanyl-contaminated drugs<\/a>\u00a0\u2014 which are more common in lower-income neighborhoods \u2014 and less access to health care are likely factors in the growing number of overdose deaths among Black populations.<\/p>\n Jones said the criminal justice system, and its unequal treatment of Black people, also plays a role.<\/p>\n \u201cWe know that the intersection of criminal justice and substance use, and criminalization of drug use and how that disproportionately impacts minorities, can limit the accessibility of\u00a0harm reduction services<\/a>\u00a0to racial-ethnic minorities for fear of harassment by police for drug paraphernalia,\u201d Jones said, adding that even syringes obtained through needle-exchange programs\u00a0can be considered illegal paraphernalia<\/a>.<\/p>\n Fear of arrest, in turn, leads more people to using drugs in isolation.<\/p>\n \u201cThat may protect you from criminal legal involvement, but then in the event of an\u00a0overdose<\/a>, you may not have someone to help you,\u201d Jones said. \u201cSo it could be that by the time the EMS come, it\u2019s been too long for them to even consider administering naloxone.\u201d<\/p>\n An unexpected observation that Jones made in the course of her research could also be a factor in rising death rates \u2014 the fact that many of the Black people dying of opioid overdoses are older.<\/p>\n \u201cFor any other racial groups, overdose deaths peak around midlife \u2014 35, 45,\u201d she said. \u201cFor Black individuals, it\u2019s more like 55, 64, and we were wondering what was going on with that.\u201d<\/p>\n After investigating that question, Jones and her colleagues formulated a working theory.<\/p>\n \u201cThe running hypothesis for us is that this is a cohort effect,\u201d she said. \u201cIndividuals who\u2019ve been using drugs over time, particularly Black individuals back from the \u201880s and \u201890s with the\u00a0cocaine epidemic<\/a>, never stopped using.\u201d<\/p>\n Those individuals may have remained relatively stable until fentanyl began to contaminate their drug supply without them knowing.<\/p>\n \u201cSo whatever\u00a0harm reduction tools<\/a>\u00a0that you were using for so many years that\u2019s been helping you, when fentanyl\u2019s involved, it\u2019s a different game,\u201d Jones said. \u201cYou have to use less, but you have to also know that you have fentanyl in your drugs, right?<\/p>\n It\u2019s a problem that Marcia Tucker, the program director of\u00a0Pathways to Recovery<\/a>\u00a0\u2014 a partial hospitalization program focused on co-occurring substance use and mental health challenges \u2014 sees frequently among their mostly Black clients.<\/p>\n \u201cIf you come into treatment saying that I\u2019m a cocaine user, or I\u2019m a crack cocaine user, or I use marijuana, you\u2019re not even thinking that an opioid overdose or fentanyl overdose could possibly happen to you,\u201d Tucker said. \u201cAnd it does happen.\u201d<\/p>\n In fact, Tucker said, she\u2019s seen more of these kinds of overdoses over the past two years than in the three decades she\u2019s spent working in addiction treatment. Despite that, there\u2019s still a lack of education \u2014 and even stigma \u2014 surrounding both medication-assisted treatments (MATs) for\u00a0opioid addiction<\/a>, and the use of naloxone.<\/p>\n \u201cI think sometimes culturally with the African American community, as far as MATs are concerned, there are some taboos about getting that extra help when they decide to come into treatment and get clean,\u201d she said. \u201cA lot of people feel like they want to do it from the muscle. They see it as another form of using.\u201d<\/p>\n She said others may not know how to use\u00a0naloxone<\/a>, what kinds of effects it has or how to get it.<\/p>\n \u201cI think a lot of folks don\u2019t even know that they can walk into a pharmacy and get naloxone \u2014 you don\u2019t have to have a prescription for that,\u201d Tucker said. \u201cAnd I think that information is just not always presented to communities, especially poor communities that don\u2019t have a lot of resources.\u201d<\/p>\n Other sources of hesitation are more immediate. Aaron Rice, a therapist at Pathways to Recovery, said that many of their clients fear naloxone because of its physical effects.<\/p>\n \u201cI think they associate it with precipitated withdrawal at times,\u201d Rice said, referring to the rapid-onset withdrawal that can cause symptoms including anxiety, pain, seating, nausea, vomiting and diarrhea.<\/p>\n \u201cThe only thing they\u2019re thinking about is feeling better. And that feeling is going to supersede logic at that moment. It always does.\u201d<\/p>\n The Department of Health acknowledged that the study only paints a partial picture, as it doesn\u2019t include individuals whose overdoses were reversed by\u00a0naloxone<\/a>, and added that during the years of the study (2019\u20132021), naloxone was available by prescription only \u2014 a fact that likely played into the race-based disparity.<\/p>\n \u201cThere are recognized inequities in access to health care among persons of color, the concept of which likely extends to access to naloxone,\u201d the Department of Health statement reads. \u201cHistorically, many public health materials and messaging more narrowly focused on persons using\u00a0opioids<\/a>. With people now taking two or more drugs together (whether intentionally or unintentionally), public health materials and messaging need to be more inclusive of all persons using drugs, regardless of the type.\u201d<\/p>\nFear of arrest<\/h2>\n
Contaminated drug supplies<\/h2>\n
Fear, stigma and miseducation<\/h2>\n
Overcoming disparities in health care and mistrust of the system<\/h2>\n