MONDAY, Sept. 13, 2021 (HealthDay News) – The decades-long opioid epidemic in the United States could hit blacks harder than whites as the crisis enters a new phase.
Mortality from opioid overdoses among black Americans has jumped by almost 40% from 2018 to 2019 in four countries affected by the epidemic, researchers found.
The fatal ORs among all other races and ethnicities remained almost the same during this time.
This is a significant change in the opioid crisis that hit white people in rural areas in the early 2000s, said lead researcher Dr. Mark LaRochel, an assistant professor at Boston University School of Medicine.
“Since 2010, we have recognized what people call the ‘triple wave’ of the opioid epidemic,” he said. “The first wave were prescription opioid analgesics, then from 2010 to 2013 the increases were largely due to heroin, and since 2013, fentanyl has been illegally infiltrating the drug supply.”
Racial inequalities in health care and social services in the United States are likely to continue to increase OP mortality among black Americans, even as mortality among other ethnic groups equals, Laroschel and Dr. Kenneth Stoller, director of the Broadway Center at the Johns Hopkins Center, told addiction in Baltimore, which reviewed the results of the study.
The spread of the powerful opioid fentanyl across the national illicit drug market may also have played a role, they added.
“Cocaine and methamphetamine increase with fentanyl,” Stoller said. “These other drugs cause overdoses in people who are not used to using opioids whose bodies are not tolerant to these opioid drugs.”
The Larochelle team collected data for this study as part of the Long-Term Community Assistance to End Addiction, a federally funded effort to stop OD deaths in 67 communities affected by the opioid crisis.
These communities are in Kentucky, Massachusetts, New York and Ohio. The project aims to “reduce opiate overdose mortality by 40% in three years,” Laroschel said.
Overall, opioid mortality was the same in target communities between 2018 and 2019, researchers said on September 9 in American Journal of Public Health.
But a closer look, the researchers found a 38% increase in opioid overdose deaths among blacks.
Actions that have helped reduce the flow of OP deaths among other racial and ethnic groups do not appear to have the same effect on black Americans, LaRochel said.
He noted that laws have been passed to limit the illicit use of prescription opioid painkillers; communities have been trained on ways to treat overdoses and are armed with the drug to reverse OD naloxone, and drugs have become more widely available to treat people addicted to opioids.
“Unfortunately, they have been delivered in a way that reflects structural inequalities in our health and public health systems,” with benefits primarily for white people, LaRochel said.
Other issues that hinder black Americans’ access to health care probably also play a role here, Stoller added. These include lack of access to health care and affordable health insurance, lack of childcare, problems finding transport to and from treatment, and homelessness.
“All of these are just some of the many other barriers that can limit the effectiveness of what we’re trying to do to make a breakthrough” in opioid OD deaths among black Americans, Stoller said.
“Substance disorders are very complex in the way they are formed and maintained,” he added. “We need to address the supporting factors that limit access to treatment and the effectiveness of treatment for blacks.”
Fentanyl may also contribute to OD deaths among black Americans by becoming infected with other illicit recreational drugs, Laroschel and Stoller said.
“What we’re starting to see is the emergence of stimulants contaminated with fentanyl – for example, someone who intends to use cocaine and that cocaine is tainted with fentanyl,” Laroschel said. “For a non-opioid user who is exposed to even small amounts of fentanyl, this can unexpectedly lead to an overdose.”
He added that these are not the people who have usually focused on trying to reduce opioid harm because they do not intend to use opioids.
The number of this study was collected before the COVID-19 pandemic, which caused drug use and OP to start growing again among all races and ethnic groups, LaRochel said.
This means that black Americans may be even more at risk of opioid OD today than they were before the pandemic.
“The trends in this document are actually before the pandemic, but the pandemic has certainly exacerbated the overdose crisis,” LaRochel said. “Unfortunately, overall levels of overdose in the population have risen again in the context of the pandemic.”
More info
The US Department of Health and Human Services has more information about the opiate epidemic in the United States.
SOURCES: Marc Larochelle, MD, MPH, General Practitioner of Internal Medicine, Boston Medical Center and Assistant Professor, Medicine, Boston University School of Medicine; Kenneth Stoller, Ph.D., Director, Broadway John Hopkins Addiction Center, Baltimore; American Journal of Public Health, September 9, 2021