The statistic was a shocker. The state’s latest opioid figures showed that Black men in Massachusetts had died of overdoses in 2020 at a rate 69 percent higher than the previous year.
Public health officials decried the death toll as “heart-breaking” and “troubling.”
Black leaders in health care agreed — but also had another word to describe the data: unsurprising.
“This pandemic has really just shone a light on something that’s already been going on,” said Dr. Charles L. Anderson, president and CEO of the Dimock Center — which offers health services in Roxbury — noting that substance use disorders among Black men already were increasing before COVID-19.
“This was a tragedy waiting to happen that was exacerbated by COVID-19,” said Michael Curry, president and CEO of the Massachusetts League of Community Health Centers. “Let’s embrace the urgency of this like we embraced the urgency of the pandemic.”
The data on Black men stood out in a disheartening report last month, which showed overall opioid-related deaths had increased 5 percent in 2020, erasing the progress of the previous five years in combating the addiction crisis. Three-quarters of the 2,000 who died were white. But when examining death rates per 100,000, whites saw a slight decline while all other groups experienced increases, and Hispanics continued to have the highest rate.
Most startling was the trend among non-Hispanic Black males: a spike from 32.6 deaths per 100,000 in 2019 to 55.1 in 2020.
So what explains it? Poverty, job loss, and lack of access to housing and health care, which contribute to health problems including addiction, are hardly new to the Black community, said Carolyn Reynolds, associate director for behavioral health services at the Whittier Street Health Center in Roxbury.
“We’re living in a pandemic all the time,” Reynolds said.
Even before COVID-19 struck, overdose deaths were on the rise among Black people nationwide, increasing faster than the rate among whites for years. The trend showed up in Massachusetts when the numbers spiked in 2017.
Then came the loneliness and anxiety of living in a pandemic, which hit harder in communities of color, amplifying the stresses. Black people endured more illness, hospitalization, and death. They were more likely to have jobs requiring them to leave home and interact with the public. And they were also more likely to lose their jobs.
On top of that came the emotional turmoil surrounding the George Floyd murder and other reports of police violence against Black people.
“It’s been an incredibly stressful period,” said Dr. David C. Henderson, psychiatrist-in-chief at Boston Medical Center, “and it leads to an increase in adverse coping mechanisms,” such as drug use.
And when Black people use drugs, the consequences have historically been especially severe.
“We haven’t really addressed the taint of racism in how we treat substance use disorder in this country,” said Curry, of the health centers group. Racist policies have “damaged communities and families and maybe resulted in the loss of lives,” he said.
Black communities were ravaged by heroin in the 1960s and 1970s and by crack cocaine in the ’80s and ’90s. The response then was to pass tough new laws that sent thousands to prison. But when opioid use exploded among white suburbanites in the 21st century, suddenly people who used drugs were perceived as victims who needed empathy and treatment.
While attitudes have evolved, the tendency to perceive Black drug users as criminals persists, said Anderson, of Dimock. Many have internalized that notion, deterring them from seeking treatment.
And in any case, Black men are still more often sent to prison than to treatment, Anderson said. “If you’re a Black man labeled with addiction, you’re automatically at higher risk of being incarcerated,” he said.
That inequity may have had especially dire consequences during the pandemic, when most jails suspended treatment services and many who were incarcerated were released early to prevent further spread of COVID-19.
People were set free often without adequate planning to connect them to services, putting them at higher risk of overdose, said Devin Larkin, director of recovery services for the Boston Public Health Commission.
Other factors may also play a role. Joe Shay, a team coordinator for Boston Medical Center’s Project Trust, has noticed changes in drug use patterns in his five years as a street outreach worker. Opioid use has been most common among Hispanics and whites, while Blacks mostly smoked crack cocaine, he said.
But now, he said, those distinctions are breaking down.
“Drugs are so available,” Shay said. “People are using different substances, just trying different substances.”
And nearly all substances today are contaminated with fentanyl, a potent synthetic opioid that was found in 92 percent of people who overdosed. So even those who want to use only cocaine may inadvertently consume fentanyl, and overdose.
Eddie Lewis, a former ironworker who runs a class for men recovering from addiction at the Lemuel Shattuck Hospital in Jamaica Plain, said that eight participants relapsed and died during the pandemic.
“I lost a lot of friends since this COVID,” said Lewis, 60, who has been in recovery for 14 years from alcohol and cocaine use. “They’re not used to being alone.”
Many could not adapt to Zoom meetings, and, distraught and isolated, they returned to the previous drugs of choice — without realizing they were laced with potent fentanyl.
In the Black community, people are often reluctant to admit they’re injecting drugs because they don’t want to be considered “an addict,” said Henderson, of Boston Medical Center. “There’s a huge stigma about that,” which discourages many Black people from seeking treatment, he said.
But it’s not the only deterrent. Traditionally, Black people have been offered methadone, a drug that is available only at tightly regulated clinics that require daily visits. The other, newer drugs to treat addiction are discreetly prescribed in doctor’s offices — mostly to white people.
The image of people standing in line outside methadone clinics, often looking sedated, has soured Black people on medication treatment for addiction, Henderson said.
“We need to have better data and talk to people to understand what their perceptions are. What type of help are they willing to accept and participate in?” Henderson said.
When they do seek treatment, Black people face another hindrance: Most of the clinicians are white people who don’t share the same experiences.
A Black person brings memories of racism to any interaction with a white clinician, and that can get in the way. “If it’s a more diverse staff,” Henderson said, “then you don’t have to deal with that stuff. You can just get down to the treatment.”
The state Bureau of Substance Addiction Services has been analyzing the latest overdose data and working to address all these issues, said Deirdre Calvert, the bureau’s director.
“It’s heartbreaking and shocking and unacceptable,” Calvert said of the death rate among Black people. “We take this incredibly seriously.”
The state recently awarded $2.3 million in grants to nonprofits providing recovery services to people newly released from prison or jail, focusing on neighborhoods with high rates of fatal overdoses among Black and Hispanic men. The state also funds programs to train Black and Hispanic addiction counselors.
The bureau has started digging into its data to tease out the ages, locations, and circumstances of the people most affected, Calvert said.
While the pandemic has worsened the opioid crisis, Calvert said, it has also provided a source of inspiration — in the way vaccines were brought directly to the people, at their churches, gathering spots, and workplaces.
“We need to do that same thing,” she said. “We need to figure out how to connect better with this population.”