When the first phase of the opioid epidemic was cresting in 2010, driven largely by prescription pain medications, white Americans were dying of fatal drug overdoses at rates twice that of Black Americans.
In the decade that followed, drug deaths surged again. But this time Black communities faced the brunt of the carnage.
"Overdose rates have been growing fastest among Black communities," says Joseph Friedman, an addiction researcher at UCLA. "For the first time we see them overtaking the overdose rate among white individuals."
It's a devastating milestone, documented in a peer-reviewed study published Wednesday in the journal JAMA Psychiatry.
The research is based on drug deaths from 1999 through 2020, the most recent comprehensive overdose data available.
The biggest factor leading to overdose deaths among Black people is a more toxic illicit drug supply
Preliminary data from the Centers for Disease Control and Prevention suggests the situation has grown even worse over the past year as fatal overdoses topped 100,000 for the first time in 2021.
Friedman says the biggest factor leading to dramatically higher overdose deaths among Black people with substance use disorder is pretty simple: "The illicit drug supply, the street drug supply, is becoming more and more toxic," he says.
That's because of fentanyl, the potent synthetic opioid, which Mexican drug cartels now mix into many of the street drugs sold in the U.S.
Fentanyl has made drug use far deadlier for all Americans, across all demographics.
But this new study suggests African Americans are more vulnerable because they often rely on illicit drug supplies that are even more high-risk.
"People who are lower down on the social hierarchy tend to be exposed to fentanyl and other highly potent synthetic opioids at disproportionate rates," says Dr. Helena Hansen, a co-author of the report.
As a consequence, "You find Black Americans are exposed to fentanyl more often than white Americans," she says.
Black Americans with addiction more vulnerable to fentanyl
Hansen, who is Black, is also a researcher at UCLA. She says African Americans with substance use disorder also frequently lack access to healthcare and drug treatment. They're arrested and incarcerated at a far higher rates.
This means they tend to have fewer chances to get healthy and the avoid relapses that expose drug users to fentanyl.
"We have in this country two tiers, a criminalized tier which still over-polices and over-arrests and over-incarcerates Black and brown Americans," Hansen says. "And then we have a medicalized tier" that's more available in white communities.
Another 1.2 million drug deaths forecast across all demographics
This research follows a study published last month in the medical journal the Lancet that forecast more than 1.2 million additional drug overdose deaths in the U.S. in the coming decade.
On reviewing the demographic study conducted at UCLA, Dr. Stephen Taylor with the American Society of Addiction Medicine says the data suggest the Black community may bear the brunt of the next phase of the opioid epidemic.
"As a member of the Black community and as an addiction treatment specialist ... I'm terrified of that prospect, but that's exactly what we could be facing," Taylor says.
"A larger percentage of this next million [deaths] will be Black and other people of color."
Researchers say the way to prevent many of those deaths in the Black community is well documented in scientific and medical literature: provide better healthcare and more access to addiction treatment.
"All of this needs to be done with a real sense of urgency," Taylor says.
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