The COVID-19 pandemic brought national attention to the healthcare disparities between Whites and racial & ethnic minority groups. As if the racial-specific data for pandemic deaths was not enough, there is now data showing the heartbreaking connection between COVID-19 and increased opioid overdoses among minorities, specifically Black, Hispanic/Latino, and Native American populations.
Earlier this month, the U.S. Centers for Disease Control and Prevention (CDC) reported more than 93,000 people died from overdoses in 2020 in the midst of COVID-19 . This was a 29.4% nationwide increase from 2019. But the percentage growth broken down by minority population is significantly greater than 29%.
A study by researchers at the University of California, Los Angeles, found that Black people had the largest increase in drug overdose deaths: their death rate jumped 50.3% in 2020. Hispanic/Latinos followed close behind at 49.7%.
Opioid overdose data for American Indians (AIs) and Alaska Natives (ANs) during the COVID-19 pandemic, on the other hand, is uncertain. Even though AIs and ANs experienced the largest opioid death rates in the United States in 2017 (7.2 deaths per 100,000 people), data on this population for 2020 is currently hard to find, if it was reported at all.
The spotlight on the pandemic’s healthcare disparities for minorities spilled-over to the opioid epidemic, and rightfully so – the numbers speak for themselves.
But which opioids were behind these minority populations’ increased death rates? And what barriers might have kept them from receiving treatment?
Black Americans were increasingly dying from opioid use, specifically from exposure to illicit fentanyl. In the first six months of 2020, fentanyl deaths in St. Louis increased 64% among Black Americans (versus 40% among Whites) compared to the same timeframe in 2019; this trend also was true of other major U.S. cities.
One factor that’s contributed to increased deaths for Blacks is disproportionate medication assisted treatment (MAT). MAT for opioid addiction could include methadone, buprenorphine, or naltrexone, with buprenorphine being one of the most successful for substance use disorders (SUD). But one study found that for every appointment Black patients received a prescription for buprenorphine, White patients had 35 such appointments.
According to the American Medical Association, other barriers to substance use disorder treatment for Black Americans include fear of legal consequences, significant mistrust of healthcare and social services, and a shortage of Black physicians and providers.
Of all people of color who were likely to start or increase substance use to cope with pandemic-related stress or emotions, Hispanics/Latinos were found to be the leading group at 21.9% more likely, compared to Blacks at 18.4%.
With this in mind, a study of data from the National EMS Information System found that both Hispanics/Latinos and Blacks experienced the largest increases in overdose-related cardiac arrests during the COVID-19 pandemic; Latino overdose-related cardiac arrests spiked 49.7% from March to October 2020 compared to the same dates in 2019.
Challenges that Hispanic/Latino populations face to receive treatment for opioid use disorders (OUD) can include immigration issues, language barriers, misperceptions about OUD and SUD, and less access to MAT such as buprenorphine.
American Indians (AI) and Alaska Natives (AN) have been underrepresented in data about COVID-19 cases and in data about opioid-related deaths. The CDC did not report race/ethnicity data in weekly COVID-19 updates until April 2020 and, in some areas, AIs/ANs were classified as an “Other” ethnicity. When it comes to opioid overdoses, in recent years Native Americans’ opioid death rate has been severely miscalculated in states like Oklahoma because AIs were mistakenly classified as “White” on death certificates.
However, it is known that AIs and ANs have the second highest rate of opioid overdose deaths among U.S. ethno-racial groups and are 12 times more likely than any other group to die from a methamphetamine overdose.
Native Americans’ higher risk of overdose is due to lack of access to medical care on reservations, exclusion from public-funded health initiatives, historical trauma, and limited resources such as running water and housing.
Pre-COVID Pandemic Overdose Increases
It’s important to note that the COVID-19 pandemic was not the only culprit for increased overdose deaths in these racial & ethnic minority groups. The pandemic merely escalated a pre-existing problem of addiction and growing overdose rates.
Even though data showed a decrease in nationwide drug overdose deaths in 2018, there were in fact increases among Black Americans, Latinos, and Native Americans. The overall decrease was due to the improved survival rate of White Americans that year, but the death rates of minority groups had grown – and continued to grow into 2019 – before the pandemic had even hit.
The deadly drugs behind these growing number of deaths? Synthetic opioids. Synthetic opioid deaths among minority groups were responsible for the jump from 9 deaths per 100,000 people in 2017 to 9.9 deaths by 2018.
Opioid deaths also seemed to affect minorities in different regions around the country. Data from the Kaiser Family Foundation in 2018 showed that states with larger Hispanic/Latino or Black populations had higher rates of opioid overdoses among their adult populations, respectively. California, New Mexico, and Texas saw higher death rates in Hispanic/Latino populations, and Illinois, Michigan, and Missouri saw a similar trend among Black adults.
A CDC study conducted from 1999 to 2015 found that American Indians and Alaska Natives showed the greatest increases – a 519% increase, to be exact, and more than any other racial & ethnic group – in opioid-involved and heroin-involved overdose deaths. On the tail end of that timeframe, Native Americans were found to be 50% more likely to die of an opioid overdose than non-natives from 2006 to 2014, and specifically from methamphetamine from 2011 to 2018.
This, however, does not minimize the sad reality of the significant increases in other minority populations. From 2013 to 2017, the U.S. Agency for Healthcare Research and Quality found that synthetic opioid deaths (other than methadone) per 100,000 people had increased 18-fold for non-Hispanic Blacks and 12.3-fold for Hispanics, while non-Hispanic Whites saw a 9.2-fold increase. By 2017, opioid-related overdose deaths were significantly higher among Blacks and AIs/ANs, and synthetic opioids impacted Hispanics more than any opioid.
There Is Work To Do
The overwhelming data and research is calling communities, organizations, and policy makers to action. Last year marked the worst single year in the history of the opioid epidemic, with people of color experiencing the highest death count. They and other marginalized communities deserve better – better treatment and better odds for healthier lives.
It will be incredibly important to increase overdose prevention efforts and to provide quality treatment for these minority racial & ethnic communities. And it should be urgent: We have yet to see the residual impact of COVID-19 on the mental health of these populations. New research is showing a growing epidemic of “deaths of despair” through substance abuse and suicide because of the pandemic.
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