Opioid Addiction: A Matter of Black and White?

Blacks are prescribed less opioids than whites, often because of unfounded speculation. (Courtesy of Everyday Health)
Blacks are prescribed less opioids than whites, often because of unfounded speculation. (Courtesy of Everyday Health)

The rate of heroin-related overdose deaths nationwide has nearly quadrupled since 2002 as an estimated 30,000 people die every year from opioid overdoses.

However, unlike drug epidemics of the past, minority populations have seen a less dramatic increase in drug addiction and deaths compared to young white adults.

Minority patients use fewer opioids, researchers say, and a 2016 study found that black patients are significantly less likely to receive opioids when they visit an emergency room for non-definitive abdominal or back pain.

Pain researcher Adam Hirsh at Indiana University-Purdue University in Indianapolis said doctors may falsely believe black patients are more likely to abuse drugs.

Also, they may empathize less with patients of a different race and underestimate how severe their pain is, as just 4 percent of American doctors are black, Hirsh said.

Unlike drug epidemics of the past, minority populations have seen a less dramatic increase in drug addiction and deaths compared to young white adults, according to modernhealthcare.com.

The rate of heroin use among white adults increased by 114 percent between 2004 and 2013, according to the Centers for Disease Control and Prevention. The rate among nonwhite adults remained relatively unchanged during that same period.

Dr. David Rosenbloom, professor of health policy and management at Boston University’s School of Public Health, told modernhealthcare.com that he thinks he knows why.

“Blacks have been undertreated for pain for decades,” he said.

The stark rise in addiction can be traced back to the increased use of prescription pain relievers such as OxyContin and Vicodin.

Prescriptions for opioid analgesic medications have skyrocketed since the introduction of OxyContin in the mid-1990s. In 2012, the number of prescriptions written for opioid drugs reached 259 million.

Regulators only a few years ago began implementing stricter limits on the number of pain pills doctors could prescribe, which resulted in lower prescribing rates for opioids, but also led to a subsequent rise in heroin use, a cheaper and easier alternative to prescription pain medicines.

A 2008 JAMA study found minorities were less likely to receive opioids for pain in an emergency department compared to whites.

Some say physician prejudice leads many to prescribe opioids less frequently for black and Latino patients than for whites.

“It would appear that the prescriber may be more concerned about the possibility of the patient getting addicted or maybe the possibility that the pills will be diverted and sold on the street if the patient is black,” said Dr. Andrew Kolodny, executive director of Physicians for Responsible Opioid Prescribing. “If the patient is white, they may feel like there’s nothing to worry about.”

Still, others contend the problem may have more to do with white patients having traditionally had greater access to health care services compared to minority patients, increasing their likelihood of receiving pain treatment.

“It could be that the overall ability to be able to be prescribed these medications has resulted in more exposure among whites and more risks in terms of addiction and overdose,” said John Kelly, an associate in psychiatry at Massachusetts General Hospital in Boston.

Many believe the changing face of drug abuse is behind the urgent call to action among presidential candidates, lawmakers and law enforcement officials.

That could also be true for the increased call for treatment rather than the previous “war on drugs,” which concentrated on mass arrests and incarceration.

“I think it was pretty clear that our response during the crack cocaine epidemic was largely a criminal justice response,” Kolodny said. “Whenever you hear people talking about our opioid crisis, within the first few minutes you hear someone say something to the effect that we can’t arrest our way out of this problem.”

Locally, the response to the opioid epidemic can be roughly split into three parts — prevention, treatment and enforcement, said Hadi Sedigh of the Justice and Public Safety Division of the National Association of Counties in D.C.

On the prevention front, cities and counties have been focusing on increasing public awareness about the dangers of prescription and illicit opioids, Sedigh said.

“They’ve done this through programming in schools and colleges, but also through innovative approaches to connecting with the general public in various contexts,” he said. “In Erie County, Pennsylvania for example, the county aims to educate parents about adolescent drug abuse through ‘open-bedroom’ displays located in shopping malls that teach parents to better recognize potential symptoms of addiction in their homes.”

Elsewhere, in Ocean County, New Jersey, “funeral cards” are passed out by local officials to funeral directors, who in turn pass them on the family members of deceased individuals.

These cards list information about safe drug disposal sites in Ocean County and aim to decrease the chances that prescription drugs left behind by the deceased are later misused by others.

In terms of treatment, cities and counties have largely focused on increasing the availability of medication-assisted-treatments (MATs) and the overdose antagonist naloxone.

MATs typically involve a regimen of long-term medication exchange such as methadone, buprenorphine or naltrexone replacing heroin, in conjunction with psychological counseling, peer-to-peer support networks and close patient monitoring.

“MAT is considered the evidence-based model to address addiction and co-occurring mental health problems,” Sedigh said. “Naloxone, meanwhile, has already saved countless individuals who have experienced opioid overdose, and many cities and counties have made a concerted effort to make the drug more widely available to first responders and to the community at large.

“It may not be widely known that in many localities, naloxone is available without prescription to family members and friends of individuals struggling with opioid addiction,” he said.

There have been several state and national reports on how to curb the opiate epidemic, said Dr. Bankole Johnson, alumni professor and chairman of the Department of Psychiatry and Neurobehavioral Sciences at the University of Maryland.

“Both point to the need for the medication assisted care as the opiate addiction has neurobiological underpinnings, individualized and evidence-based care, staring care where the patient makes first contact,” said Johnson, who also served as principal investigator on National Institutes of Health-funded research studies utilizing neuroimaging and molecular techniques.

“Most care needs to be outpatient based and focused on keeping individuals in touch with community, and there is little rationale for a service that over-emphasizes inpatient treatment, although some with severe or complicated disease states might need it,” Johnson said.

Cities and counties have taken significant steps to assess and fine tune their law enforcement agencies’ response to addiction, Sedigh said.

“Reduction of illicit supply of opioids remains a priority for these law enforcement units, and cooperation at the regional, state and federal level has proved critical to efforts to decrease the availability of illicit drugs in local communities,” he said.

About Stacy Brown 197 Articles
I’ve worked for the Daily News of Los Angeles, the L.A. Times, Gannet and the Times-Tribune and have contributed to the Pocono Record, the New York Post and the New York Times. Television news opportunities have included: NBC, MSNBC, Scarborough Country, the Abrams Report, Today, Good Morning America, NBC Nightly News, Imus in the Morning and Anderson Cooper 360. Radio programs like the Wendy Williams Experience, Tom Joyner Morning Show and the Howard Stern Show have also provided me the chance to share my views.