Why Aren’t We Talking About Black Americans & Opioids?

Learn about the intersection of Black Americans & the opioid crisis during Black History Month. Discover insights & solutions to address this critical issue.

Arthur Robin Williams, MD
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It’s Black History Month, and while a lot of racial justice issues deserve our attention, one that really needs to be discussed is the opioid crisis. 

2020 marked the first time since 1999 that the rate of drug deaths — mostly opioid-related — among Black people in the U.S. surpassed the rate among whites. Overdose death rates per 100,000 among Black people reached 36.8 — which was 16.3% higher than that for white people. 

Today, synthetic opioids like fentanyl are the leading cause of opioid-related overdoses in the U.S., according to the Centers for Disease Control and Prevention (CDC). But it wasn’t always this way. Understanding the shift from prescription opioids to heroin, and later, fentanyl, is at the heart of the conversation. 

The changing face of opioid addiction over the years

In the 1990s, prescription opioids were marketed aggressively – but it was white Americans who were the key target audience. Whether it was because doctors falsely believed that Black people were more likely to become addicted to or sell the drugs, or because they were less empathetic to the pain of Black people, this population received far fewer prescriptions than white Americans. 

Make no mistake — this underprescribing of pain medications to Black people was problematic, and not just because of the stereotypes embedded in doctors’ beliefs. It’s also because Black people were more likely to go without pain relief under excruciating circumstances where medication was needed. In fact, studies showing that nonwhite patients receive less pain treatment are rampant.

But the epidemic has gone through a shift that has literally changed the face of opioid addiction. Prescription opioids are definitely still a factor in the opioid crisis — they accounted for 24% of all opioid overdose deaths in 2020. However, the share has declined considerably since 2007 when 78% of all opioid overdose deaths were attributable to prescription opioids. 

Clearly, the opioid epidemic is still raging, meaning that deaths involving illicitly manufactured opioids — most notably, fentanyl — have vastly increased. Fentanyl is readily — and often cheaply — available, so Black Americans are less affected by racial bias within the healthcare system that prevents them from accessing the drug. 

As a result, opioid overdose deaths for Black Americans have skyrocketed. According to a 2023 CDC report, more Black Americans died from fentanyl overdoses than from any other drug in 2021 at far higher rates than whites or Hispanics. 

Since 2013, there’s also been a big spike in overdose deaths among Black men older than 55 – in large part attributable to fentanyl. By 2019, the opioid overdose fatality rate among older Black men was approximately four times higher than the overall rate among older adults, at more than 40 deaths per 100,000 population. 

The treatment divide

As providers of evidence-based Opioid Use Disorder (OUD) care, we believe an important conversation to have now is not just what got us here — but what can be done right now to ensure that Black Americans don’t continue to die at these alarming rates. 

Because even when Black patients start a prescription for life-saving buprenorphine, there are barriers that prevent them from staying on it. A 2022 study published in JAMA Psychiatry found that the percentage of minority patients who stayed on buprenorphine for more than 180 days was significantly below that of white patients. 

Medication for opioid use disorder has been shown to reduce the mortality rate among people addicted to opioids by at least half, but longer treatment duration is associated with better outcomes — namely avoiding the risk of overdose and relapse. 

With that in mind, not everyone has equal access to buprenorphine in the first place. Research consistently shows that Black patients have significantly lower odds of receiving buprenorphine prescriptions. 

How telemedicine can help Black Americans with OUD 

Black Americans have not had the same level of access to treatment or harm reduction services that can protect them from overdose, and the results are fatal. Many Black Americans, especially those who reside in urban areas, find their treatment options may be more limited to methadone clinics. These clinics necessitate daily visits and treatment requirements that can make successful long-term retention challenging. 

Telemedicine, while not a panacea for the opioid crisis, should be at the forefront of anyone who cares about driving change. Of course, tackling the problem also requires factors like addressing root causes of drug use, reducing the supply of illicit opioids entering the United States, and making harm reduction strategies readily available. But expanding access to treatment is a critical piece of this complex puzzle, and yes, telehealth — supported by insurance plans that many Black Americans have access to — can play a key role.

After all, telehealth can radically close the gap in treatment deserts and reduce overdose deaths. Patients can see a licensed provider from home, and that makes buprenorphine treatment available anywhere. Keeping a job is not compromised the way that it is when daily visits to a treatment clinic are a requirement. And people who are rightly scarred by the negative experiences they’ve had with providers get a shot at a new relationship with the healthcare system — one in which patients don’t have to feel rushed or judged. 


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