How the Opioid Epidemic Disproportionately Affects Minorities in the United States

Opioids are a class of drugs derived from the poppy plant which contains a naturally-occurring substance, opium. These drugs are either derived from opium, or mimic its effects on the brain and are particularly potent painkillers. Coined by researchers Anne Case and Angus Deaton to explain rising mortality rates in the United States, the term “deaths of despair” refers to deaths resulting from suicide, alcohol abuse and drug overdoses, particularly opioids. (Schneider & Schneider, 2020, 48) 

The opioid epidemic is particularly alarming, with over 75% of the 107,000 drug overdose deaths in the United States in 2021 resulting from opioid overdoses (CDC, n.d.). It took place in three waves, originating in the 1990s due to a push for targeted treatment for chronic pain. This led to the pharmaceutical company Purdue Pharma releasing the drug OxyContin. An intense marketing campaign was launched, claiming that less than 1% of patients were likely to develop an addiction due to the long-acting nature of the drug. Although this was a wildly inaccurate claim with no scientific basis, it was still accepted by the FDA; doctors were encouraged to prescribe the highest possible doses for increased profit. Due to its water soluble nature, it was absorbed very quickly into the bloodstream and rapidly produced euphoric effects.

Eventually, it was introduced into the black market, where it was used for the production of a highly concentrated, heroin-like drug. The number of people who admitted to using OxyContin for non-medical purposes increased from about 400,000 in 1999 to 1.9 million in 2002. (Woodcock, n.d.)When it was reformulated to prevent crushing or injection, it was quickly replaced by heroin, signaling the beginning of the second wave of the epidemic around 2010. In 2013, fentanyl, an even more concentrated painkiller, sold at a lower price but with higher potency, found its way into the black market. Lack of awareness about its dose potency led to a sharp rise in overdose rates, and along with other synthetic narcotics, fentanyl caused the third wave of the epidemic to begin.

While the initial focus during the opioid epidemic was its impact on rural White populations, it quickly became clear that this crisis worsened pre-existing health disparities for minorities in the United States. Black individuals in particular were disproportionately affected, with opioid-related deaths exceeding those among White individuals by four-six fold. (Gondré-Lewis et al., 2022, 2039-2053) It was observed that black individuals aged 25-34 experienced the largest increase in opioid overdose- related deaths in metropolitan areas, particularly low-income fringe neighborhoods (Lippold et al., 2019, 267-273). This disproportionate burden on minority communities can be attributed to a number of factors, many of which are surprisingly non-medical. The primary reason for the disparity within the opioid epidemic is a difference in socioeconomic status. Individuals with a lower socioeconomic status are exposed to a greater number of stressors and lack financial stability, job security, and consistent access to healthcare. They are also more likely to live in unstable neighborhoods and are exposed to greater instances of violence and traumatic incidents. These factors, along with racial discrimination, leave minorities more vulnerable to substance use disorders and less likely to have adequate support and treatment for the same. 

Moreover, individuals from minority communities in the United States also face disproportionate rates of incarceration for substance abuse-related offenses, causing a higher risk of overdose-related deaths post-release. (Nosrati et al., 2019, 326-333) They face severe social stigma, difficulty in securing employment post-release, along with an exacerbation of difficulties in accessing healthcare. If the withdrawal symptoms are not treated promptly  they are at an increased risk of drug overdose and eventual death.

Combating the opioid epidemic and ensuring that it does not further exacerbate health disparities for minority communities requires a multi-prong approach. Not only is it important to increase awareness about the dangers of opioid overdose, it is also necessary to create targeted interventions for minority communities. Examples would include setting up free or low-cost rehabilitation centers in low-income neighborhoods, after-school programs for children or vulnerable adolescents, and improved social support systems for individuals in recovery. Harm reduction, an approach which works directly with individuals who use drugs to prevent overdose or infectious disease transmission, is especially helpful as it equips individuals with the resources and information to improve their quality of life, without stigmatizing or isolating them.

It is unfortunate that a class of drugs intended to relieve pain has now become the very cause of pain and suffering for thousands of individuals in the United States, and to address this successfully, we must  address the pre-existing disparities that cause minority communities to be especially vulnerable to this crisis.

References

Gondré-Lewis, M. C., Abijo, T., & Gondré-Lewis, T. A. (2022, September 6). The Opioid Epidemic: a Crisis Disproportionately Impacting Black Americans and Urban Communities. Journal of racial and ethnic health disparities, 10(4), 2039-2053. PubMedCentral. 10.1007/s40615-022-01384-6

Lippold, K. M., Jones, C. M., Olsen, E. O., & Giroir, B. P. (2019). Racial/Ethnic and Age Group Differences in Opioid and Synthetic Opioid–Involved Overdose Deaths Among Adults Aged ≥18 Years in Metropolitan Areas — United States, 2015–2017. MMWR. Morbidity and Mortality Weekly Report, 68(43), 967-973. 10.15585/mmwr.mm6843a3

Nosrati, E., Kang-Brown, J., Ash, M., McKee, M., Marmot, M., & King, L. P. (2019). Economic decline, incarceration, and mortality from drug use disorders in the USA between 1983 and 2014: an observational analysis. Lancet Public Health 2019, 4, 326-333.

Schneider, M.-J., & Schneider, H. S. (2020). Introduction to Public Health. Jones & Bartlett Learning.

Understanding the Opioid Overdose Epidemic | Opioids | CDC. (n.d.). Centers for Disease Control and Prevention. Retrieved March 10, 2024, from https://www.cdc.gov/opioids/basics/epidemic.html

Woodcock, J. (n.d.). Timeline of Selected FDA Activities and Significant Events Addressing Substance Use and Overdose Prevention. FDA. Retrieved March 10, 2024, from https://www.fda.gov/drugs/information-drug-class/timeline-selected-fda-activities-and-significant-events-addressing-substance-use-and-overdose