The opioid epidemic has long been portrayed as a crisis among white Americans, but increasingly, Black people are dying of overdoses at alarming rates.
A study led by Boston Medical Center researchers, published Thursday, shows that in 2019, for the first time, Black people died of overdoses at higher rates than white and Hispanic people. The study examined data from 67 communities in four states, including Massachusetts.
The death rate among non-Hispanic Black individuals, in the communities studied, increased from 31.3 per 100,000 adults in 2018 to 43.2 per 100,000 in 2019, a 38 percent rise. Meanwhile, overdose deaths declined slightly among non-Hispanic white individuals and stayed level among Hispanics.
“Unfortunately, we’re continuing to see worsening trends in opioid overdoses among Black non-Hispanics, while overdose deaths have leveled off in other groups,” said Dr. Marc Larochelle, the study’s lead author, a general internal medicine physician at Boston Medical Center, and an assistant professor of medicine at Boston University School of Medicine.
Brendan Saloner, an associate professor of addiction and overdose at the Johns Hopkins Bloomberg School of Public Health, called the research “an interesting corroboration of something that we are starting to see in the national data.”
“We’ve got to totally bust up the narrative that the overdose crisis is a crisis mainly for white rural and suburban America,” said Saloner, who was not involved with the study. “If that was ever true, it’s certainly not true now.”
The report, published in the American Journal of Public Health, is among the first research papers to emerge from the HEALing Communities study, a $350 million project that started in 2019. As part of its Helping to End Addiction Long-term Initiative, the National Institutes of Health project is testing possible solutions to the opioid crisis in hard-hit communities in Kentucky, Massachusetts, New York, and Ohio. Boston Medical Center is leading the project in Massachusetts.
Researchers gathered death certificates in the 67 communities, which together have a population of 8.3 million, and analyzed trends in opioid overdose deaths overall and by race and ethnicity.
Overall, no change was found in the opioid-related death rate from 2018 to 2019. But among Black residents, striking increases were found in Kentucky and Ohio. Higher rates were also seen in Massachusetts and New York, but they were not statistically significant.
But data released in May by the Massachusetts Department of Public Health showed a sharp increase in fatal overdoses among Black people. From 2019 to 2020, the rate rose from 22.1 per 100,000 people to 34.8.
Larochelle said the reasons for the increase are not entirely clear.
“It’s a great question, and one we don’t fully comprehend yet,” Larochelle said. Efforts to address the opioid crisis may have bypassed the Black community, he said. “There are structural issues in how these services are deployed.”
For example, the highly effective drug buprenorphine, which quiets cravings for opioids and prevents overdoses, is more readily available in doctor’s offices in white suburban communities, Larochelle said. In Black communities, often the only option is methadone, which is also effective but available only in tightly regulated clinics requiring frequent visits.
Another factor may be the widespread contamination of the drug supply with fentanyl, a powerful synthetic opioid. Both Larochelle and Saloner said it’s possible that many have died from unwittingly taking cocaine that contained fentanyl. Stimulant users are at higher risk of fentanyl overdose because they haven’t developed physical tolerance for opioids.
Harm reduction programs — which distribute clean needles and the overdose-reversing drug naloxone, and also test drugs for fentanyl — have focused on helping people who inject drugs.
“Folks who are primarily stimulant users are not walking through the doors of those agencies,” Larochelle said.
Racist practices in law enforcement also play a role, Saloner said. Black and white people use drugs at the same rate, but Black people are much more likely to be arrested and prosecuted for it, he said.
“The fact that there is such a high risk of getting arrested leads to less safe drug use,” Saloner said.
The data in the study was gathered at the request of the participating communities, who wanted to look for evidence of racial inequities. And the findings have influenced the communities’ plans.
“We do have a playbook for reducing overdose deaths,” Saloner said. “The key is to make sure those strategies are implemented widely in all communities.”