Racial and Ethnic Disparities in the Governance of Opioid Crisis in the United States

Abstract

Context: For two decades, opioid-related overdose fatalities have surged among White, non-Hispanics in rural and suburban communities across the United States, often seen as the face of this epidemic. However, urban minority communities have also experienced a significant rise in opioid overdoses, a trend not fully addressed in the literature.

Methods: We used the CDC’s WONDER platform to obtain age-adjusted drug overdose mortality rates per 100,000 population for Hispanic and non-Hispanic individuals between 2010 and 2023. The data showed significant differences in mortality rates over the years, underscoring the changing nature of substance abuse crises. The analysis was conducted by year, state, drug type, and race and ethnicity.

Results: We observed the racial and ethnic disparites in the governance of Opioid Crisis in the United states. According to CDC data, from 2010 to 2021 in the United States, White, Non-Hispanics experienced the highest rates of opioid overdose deaths amongst any ethnic group. However, greater increases have been reported for Blacks during the same timeframe, with AARs rising from 3.5 overdoses per population of 100,000 in 2010 to 12.9 overdoses per population of 100,000 in 2021, highlighting a troubling escalation in opioid-related fatalities within the Black community. This paper shows that deaths among non-Hispanic Black men appear to account for the disproportionate increase in rates of opioid overdose deaths for all older adults since 2013. Simultanoeusly, we observed different patterns across race/ethnicity groups for opioid and stimulant treatment rates among males between 2010-2021. Racism may be associated with these disparities. In terms of racism, many potential factors could contribute to higher fatality rates among the non-Hispanic Black population in general and among men in particular. These factors include the consequences of structural racism, such as disparate access to SUD treatment; bias in addiction treatment; residential concentration in low-resource communities with limited access to good schools, health care, and healthy foods; medical mistrust; and raially biased drug policies. State-specific data from 2023 further reveal that the mortality rate for Black people in some states has far exceeded that of white people. For example, in Michigan, the Black death rate was 70.0 per 100,000 people, compared to 24.0 for white people. In Washington, D.C., the Black death rate was 58.0 per 100,000 people, also significantly higher than the white death rate of 20.0 per 100,000 people. The death rate for Hispanics and American Indians/Alaska Natives (AI/AN) in some states also exceeded the national average (23.7 per 100,000 people). These data highlight the severe impact of the opioid crisis on minority communities.

Conclusion: Over the past two decades, the face of the opioid crisis has been one of White middle class prescription users in contrast to the War on Drug’s minority heroin users. Inaccurate portrayals of opioid use have led to different policy approaches, with minorities viewed as addicts rather than victims in comparison to their White counterparts. Punitive versus rehabilitative policy approaches can have long lasting negative and devastating effects in disadvantaged communities. While opioid-related overdoses have predominantly affected rural and suburban White, non-Hispanic communities, there has been a significant rise in deaths among Black and Hispanic minority communities in recent years. Despite this, the media often portrays the epidemic as a crisis primarily impacting White, non-Hispanic rural and suburban areas. Consequently, the governance including intervention strategies and policies have failed to adequately address the severity of the problem in minority communities and to provide culturally adaptive prevention and treatment options. This paper will examine the impact of the Opioid Crisis on Black and Hispanic minority communities. It will compare the current U.S. government’s approach to the epidemic in rural and suburban White America with its past criminal justice response to drug crises in urban minority communities. The paper will also discuss cultural adaptive policy recommendations to mitigate and offer treatment options for the opioid epidemic in these minority communities. This paper suggests that ‘Whitewashing’ this epidemic has led to the neglect of rising death rates in minority communities. To rethink policy implications, the U.S. government must change its approach to ensure that everyone affected by the opioid epidemic, regardless of race or ethnicity, is included in the dialogue to address this crisis.