America’s overdose crisis has put the spotlight on racial inequalities in drug policy, according to several experts.

Recent data from the Centers for Disease Control and Prevention (CDC) showed that fatal drug overdoses were up 28.3% for the 12-month period ending in September 2020, driven in large part by the synthetic opioid fentanyl. And Black Americans were hit the hardest by overdose deaths.

“There are some who say: ‘When America has a cold, Black America has pneumonia,’” Tracie Gardner, vice president of policy advocacy at the Legal Action Center, told Yahoo Finance (video above). “It’s this idea that the inequities that have been perpetuated our entire time in this country have been cumulative. It’s been generational. And each year we don’t address the structural problems, we just pile on more to systems that can’t care.”

In addition to a drug overdose epidemic over the last decade, the U.S. has been grappling with a coronavirus pandemic over the last 16 months that has been particularly devastating for communities of color.

Black Americans are 2.8 times as likely as their white counterparts to be hospitalized from COVID-19, the disease caused by the latest coronavirus, and 1.9 times more likely to die from it. There's no one clear answer as to why that is, though it's likely connected to socioeconomic factors such as income level, housing situations, and overall well-being.

“We started out on broken footing,” she said. “I’m not saying that Black people are broken but just the infrastructure — because that also tells us why COVID ravaged so many Black communities in such a disproportionate way — needed to be there that keeps communities healthy and safe has never been invested in.”

Gardner noted that she saw this first-hand in April 2020, when New York City was the epicenter of the global pandemic.

“That’s really one of the striking things about COVID that I’ll never forget because I’m in Brooklyn, and I’m in between two large hospitals that treat predominantly the Black and Latino communities,” she said. “Early on, when people were saying that COVID was a hoax and they were showing the parking lots of hospitals where it was all calm and nothing was going on — those hospitals weren’t in Black communities.”

She continued: “All summer of 2020, there were refrigerated trucks going back and forth because the number of dead in these hospitals was more than their capacity could handle. So that’s about the racism inherent in location — where we live in our communities are not only sick, i.e. health inequities, racial disparities in health, or the social determinants are weak, which makes our ability to access health difficult.”

'That connection is seen as life or death'

The impacts of the overdose crisis and global pandemic on Black communities are connected, according to Gardner, given that access to health care also affects treatment for substance use disorder, which was made extremely difficult because of the virus.

During the pandemic, nationwide shutdowns meant that those seeking treatment weren’t able to go anywhere in person to obtain their medications, and many were left vulnerable due to isolation, massive job losses stemming from the economic recession, and a deadly virus.

“There’s a saying that the opposite of active addiction is community,” Gardner said. “It’s not treatment, it’s community, and it’s being able to be supported in your goals. The 12-step groups that I’m part of immediately activated themselves when the shutdown happened — immediately. They were some of the first and biggest users of Zoom because that connection is seen as life or death.”

Nora Volkow, director at the National Institute for Drug Abuse (NIDA), explained that the current social circumstances are “very stressful,” especially for those already struggling.

“The way that some people cope with it is to take drugs,” Volkow told Yahoo Finance. “That’s one element. The vulnerability is higher. And then the other one is the drugs that are accessible. This has been something that we’ve been noticing over the past five years that more and more the illicit drug market was actually being expanded into synthetic drugs which are much more potent, and therefore much more dangerous. That’s been accelerated during the COVID pandemic.”

With so much attention focused on prescription opioids, this allowed other drugs like synthetic opioids (e.g. fentanyl) and stimulants (e.g. meth) to make their way into communities, which is part of the reason why these drugs now account for so many more overdose deaths.

These drugs tend to be sold more often in urban parts of the country, which often have large Black populations. Fentanyl is particularly dangerous — it’s 40 to 50 times stronger than street heroin.

“Since it all has infiltrated the supply so much, there can be a very tiny amount of it in the drug of choice that people may usually use and think that they’re using to avoid that risk, and they’re still overdosing,” Gardner said.

'Grounded in institutional and systemic racism'

Another racial element to the overdose crisis arises from how treatment is provided for people with substance use disorders (SUDs).

Medication-assisted treatment (MAT) — which includes buprenorphine, methadone, and naltrexone — has become the gold standard for opioid-related substance abuse disorders, though how it’s administered varies between different racial groups.

A JAMA Psychiatry study found that Black patients with substance use disorder are significantly less likely to be prescribed buprenorphine than white patients. Another study found that among nonfatal overdoses, Black patients were half as likely to obtain follow-up treatment compared to their white counterparts.

According to Beau Kilmer, director of the RAND Drug Policy Research Center, there are several factors at play, including lack of insurance (in order to pay for the treatment), transportation (in order to get to the treatment), and child care (in order to receive the treatment without worrying about the kids).

Another factor, he noted, is exposure to the criminal justice system, where he said the racial disparities in incarceration are “well-known.” This could be one of the reasons why Black Americans are fatally overdosing at a higher rate than any other racial group.

“Especially for people who are using opioids, the time immediately after they’re released from jail or prison, the risk of overdose deaths increases dramatically,” Kilmer told Yahoo Finance. “So that could be part of the story.”

Addressing the overdose crisis involves looking at the larger issue of where leadership chooses to put resources — in penalizing the people struggling, rather than investing in their recovery.

“What’s been invested in to address American Black people is law enforcement, ‘public safety’, and then, of course, the scourge — the War on Drugs,” Gardner said. “Whenever somebody declares a war on something, usually the people who are supposed to be helped end up getting hurt.”

She stressed that rather than punishing people for struggling with addiction, people should be asking why they are struggling to begin with.

“We don’t want to hear that people use for entertainment or for recreation,” Gardner said. “We don’t want to hear people use to self-medicate. We don’t want to hear that people use when there aren’t other options, when they’re bored. We don’t want to hear that.”

“And if we did,” she continued, “then we’d have a different system for addressing both people who use drugs to make sure they’re safe when they do it and people who use drugs in a way that’s problematic for them, i.e. substance use disorder and how you treat a problem that drives the substance use disorder,” Gardner said. “So all of this, as far as I’m concerned, is grounded in institutional and systemic racism, and is anti-Black.”

Adriana Belmonte is a reporter and editor covering politics and health care policy for Yahoo Finance. You can follow her on Twitter @adrianambells and reach her at [email protected].

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