Since the coronavirus pandemic shut down America, opioid overdoses have been on the rise. There are many explanations for this, including new stressors and uncertainty, general isolation, and a decline in the accessibility of recovery programs and treatment centers (US News). Though Black people use opioids at about the same rate as the rest of the general population, they have seen the highest increase in opioid deaths (SAMHSA).
There has also been a decrease in the accessibility of medication-assisted treatments (MATs), such as methadone and buprenorphine (also known as Suboxone). Buprenorphine can be prescribed by a doctor to be taken at home, but methadone requires a daily trip to the clinic. Harm reduction advocates argue that methadone maintenance should be more flexible, especially during the pandemic, and that clinics should be offering additional take-home doses for patients (Filter). However, many clinics do not provide extra take-home doses, forcing patients to risk their health to come into the clinic daily (Talk Poverty).
• If you know people who use opioids (including legal prescription opioids), consider obtaining naloxone and getting training on using it.
• Depending on your state, naloxone may be available over the counter at your pharmacy. Naloxone can also be accessed through local harm reduction initiatives. If you are having a hard time finding naloxone in your area, you can get naloxone online.
• Take a CPR training class to be prepared if you encounter someone who is unresponsive due to an overdose.
• Consider donating to harm reduction organizations that distribute lifesaving overdose reversal medications free of charge.
In Chicago’s Cook County, Black people account for half of the overdoses (Chicago Tribune). The numbers are similar in Philadelphia (Philadelphia Inquirer). Black people have also been affected by the COVID-19 virus at disproportionately higher rates nationally, making the increase in overdose deaths and the coronavirus pandemic an intertwined issue (NY Times).
Historically, the “war on drugs” targeted Black individuals, disproportionately incarcerating Black Americans, despite the fact that they do not use drugs at a higher rate than white Americans. It has led to family separations due to incarceration and a new form of slavery through prison labor. The ACLU described the war on drugs as “The New Jim Crow” in 2003 (ACLU).
The opioid crisis provoked a media discourse that is largely differentiated from the “war on drugs,” when the “crack cocaine crisis” was painted as a problem of the Black community. White Americans started dying from opioid overdoses due to the overprescription of painkillers. Discrimination in prescribing practices led to lower rates of Black people being addicted to prescription painkillers. The opioid epidemic caught the nation’s attention because of its impact on white, middle-class Americans, and helped rebrand addiction from an issue of criminality to a public health crisis (NCBI).
However, as restrictions were placed on painkiller prescriptions, more Americans turned to heroin and fentanyl. This led to an upward swing in overdoses among Black people (NY Times). However, Black people who suffer from substance use disorders are still largely invisible in the public health discourse (Addiction Psychology).
Systematic racism accounts for the disproportionate overdose rates of Black people during the COVID-19 pandemic. First of all, Black people are less likely to have access to MAT medications like buprenorphine and more likely to rely on methadone clinics. (Remember, buprenorphine can be prescribed to be taken at home, but methadone must be taken at a clinic.) Doctors have to possess a special certificate to supply buprenorphine and are limited in the number of patients they can see. Because the number of doctors who prescribe buprenorphine does not match the demand, doctors can force patients to pay out of pocket or choose to accept only private insurance (NY Times). If clinics are closed or unsafe due to disproportionate coronavirus rates, it impacts the accessibility of needed medications, leading to more relapses. There are also racial disparities in access to addiction treatment (Addiction Center) and the pandemic-related closure of support groups such as Narcotic Anonymous and Alcoholics Anonymous.
We can mitigate the impact of the overdose crisis on the Black community through better funding for treatment programs and increasing accessibility of life-saving medication-assisted treatment, such as a loosening of restrictions on the prescribing of methadone and buprenorphine. Harm reduction also has a vital role in this discourse. Everyone who loves someone who uses drugs should keep the life-saving overdose reversal medication naloxone on hand. Harm reduction initiatives are largely underfunded: private donations primarily fund organizations that provide syringe exchange services and naloxone free of charge. Some operate on the fringe of legality due to paraphernalia laws, and many states do not have syringe exchange programs at all (Drug Policy Alliance). These ideological and political barriers continue to exist in spite of evidence that these services reduce harm in the community (CDC). Donations to these programs will put naloxone in the hands of people who need it
- Overdoses are on the rise during the COVID-19 pandemic and are disproportionately impacting Black people.
- Black people have less access to addiction treatment, as well as medicated assisted therapies such as buprenorphine.
- Increased access to overdose-reversal drug naloxone can help avoid preventable deaths.