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Race and the Opioid Epidemic: Health Disparities Based on Race

An open bottle of pills with pills lying on the table beside it

For the last several years, the opioid epidemic has been making headlines with growing frequency. From political podiums to religious pulpits, from Facebook comments to front page news, everyone is talking about people overdosing on opioids and what can be done about it. One interesting data point about the current opioid epidemic is that it mainly impacts white Americans (google “opioid epidemic” and “white” or “race”—it’s fascinating!). 

According to the Centers for Disease Control and Prevention (CDC)’s Morbidity and Mortality Weekly Report, white Americans were roughly 50% and 167% more likely (respectively) to die from drug overdoses than Black and Latin@ Americans. Why would the opioid epidemic impact one race and not others—or white people and not people of color? Is the opioid epidemic racist??

Exploring this issue is important, because we know that sexual violence and substance abuse are intertwined in many ways for some survivors. As part of NSVRC’s blog series on the opioid epidemic and sexual violence, we previously explored the importance of looking at addiction when working to end sexual violence. And now we want to dive into this, in a series of three blog posts.

NSVRC has a strong commitment to racial justice. We also know oppression is risk factor to experience sexual violence, and sexual violence a historical tool of racism. We cannot talk about opioids and sexual violence without talking about race.

There are several points to consider when considering racism and the opioid epidemic. We plan to do a blog post exploring each:

  • Health disparities based on race
  • The response to the opioid epidemic is focused in suburban, white neighborhoods
  • Our response to the opioid epidemic vs. our response to the crack epidemic

Racial Disparities in the Health Care System 

Racism impacts all systems in our country, and the health care system is not exempt. Research from the National Institutes of Health states: “Racial disparities in medical care should be understood within the context of racial inequities in societal institutions. Systematic discrimination is not the aberrant behavior of a few but is often supported by institutional policies and unconscious bias based on negative stereotypes.” 

As research shows time and time again, people of color receive a lower quality of health care. This reality affects how the opioid epidemic has impacted Black and brown communities. 

But first, a little background. In the 1990s, a few pharmaceutical companies started selling highly addictive pain medication. At the same time, these companies were telling doctors and medical professionals that pain management was much more important than previously thought, and that the issue of addiction was less likely than previously thought. Doctors began prescribing pain medication at alarming rates, and people became addicted to them and began misusing their prescription. Once addicted, many people dependent on opioids began using heroin because it is a cheaper, more accessible form of the drug.

How does this connect to race and the opioid epidemic? 

The American Journal of Public Health sums this point up well below:

“In the United States, where insurance coverage and access to physicians are racially stratified, opioid prescriptions disproportionately went to White patients, whereas non-White patients, even those with access to a physician, were less likely to be prescribed opioids, which increased racial differences in opioid use.”

Dr. Andrew Kolodny, co-director of opioid policy research at the Heller School for Social Policy and Management at Brandeis University, stated that the opioid epidemic is overwhelmingly “sparing African American and Latino communities.” Dr. Kolody has an evidence-based theory as to why:

“Something that we do know is that doctors prescribe narcotics more cautiously to their non-white patients. It would seem that if the patient is black, the doctor is more concerned about the patient becoming addicted, or maybe they're more concerned about the patient selling their pills, or maybe they are less concerned about pain in that population. But the black patient is less likely to be prescribed narcotics, and therefore less likely to wind up becoming addicted to the medication. So what I believe is happening is that racial stereotyping is having a protective effect on non-white populations.”

A recent study by the University of Virginia found that medical students and residents held “false beliefs about biological differences between black and white people (e.g., black people’s skin is thicker; black people’s blood coagulates more quickly) that could affect how they assess and treat the pain experienced by black patients.” Another 2016 study found “significant racial-ethnic disparities” in opioid prescriptions given to patients when discharged from emergency rooms. 

Of course, racism in the medical field has led to many harmful outcomes for patients of color. But an odd outlying reality is that because fewer patients of color were prescribed opioids, opioid addiction took less of a hold in communities of color.

But wait, there’s more! Part 2, on ways the response to the opioid epidemic is focused in suburban, white neighborhoods,  is coming soon.

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