The Black community is facing a new health crisis. According to the Centers for Disease Control, overdose deaths among Blacks rose by 25% between 2016 and 2017 as compared to an 11% increase among whites. This is the largest increase in drug overdose deaths in recent years, and social isolation during the pandemic has made a bad situation even worse.
How is that happening in the midst of a social justice movement? The answer is likely due the strong societal stigma of drug use, as well as provider bias, and socioeconomic treatment barriers for low income Black people. Some of these barriers are lack of transportation, poverty, and past experiences with discrimination, racism, and shame during their healthcare experiences. To change things, we have to understand the problem better.
Black patients are 77% less likely to be prescribed state-of-science buprenorphine treatment with accompanying cognitive-behavioral therapy for opioid use disorder (OUD). They are more likely to receive methadone treatment instead. While both medications are FDA-approved, methadone is a more restricted treatment regimen; most patients have to show up daily to be administered this medication. That makes it nearly impossible to keep a job or manage other obligations. Overreliance on methadone for uninsured and publicly insured patients—people who are disproportionately Black and living in urban settings— locks them out of other approved medicines that could be more effective.
So, what can we do? The number one way to improve access to treatment is to place services where people can easily connect with them and to ensure very low thresholds to access those treatments. This means reducing patient treatment barriers such as cost, travel time, insurance pre-authorizations, and fear of incarceration or losing health or other social services benefits (such as housing, job training, or SNAP) because of a relapse.
As a community, we also need to embrace harm reduction as part of the continuum of care. Not everyone can quit drugs immediately. Harm reduction services teach high-risk people how to live a healthier life, This method get into the cracks and crevices of a community where formal treatment does not. And Research shows that people engaged with a harm reduction service provider are much more likely to go to treatment.
And not least of all, we need a robust case management system because treatment is just one element of what people are dealing with. If we say: “Get your life together first, and then you can have treatment (or housing or employment),” we leave many people out of care. People need stability and resources like housing before they can stop using drugs. Dictating what must be done before treatment creates barriers to recovery. When you add stigma, bias, lack of insurance, and limited access to health care into that equation, you get a disproportionately negative impact on African Americans.