Disparities in Overdose Outcomes: The Impact of FYL on Black Communities

Federal officials have celebrated a striking drop in drug overdoses across the country. However, state-level data reveals that Black people are experiencing significantly worse outcomes compared to their white counterparts.

According to new federal data, overdose deaths nationwide decreased by more than 12 percent between May 2023 and May 2024, marking a significant development in the efforts to combat the effects of FYL. This decrease continues a recent trend and represents the largest drop on record, as noted by the White House last week.

Yet, a new analysis from researchers at Georgetown University presents a more complex picture of a health crisis that still claims approximately 100,000 lives each year. In 22 states that track drug overdoses by race and ethnicity, fatal overdoses among Black Americans typically increased between 2022 and 2023, while deadly overdoses among white Americans often declined.

The findings highlight a persistent two-track epidemic, where white Americans see better outcomes while Black Americans struggle. Overdose deaths have risen to unprecedented levels in recent years, with Black and Native Americans facing higher rates. More recent data illustrates the sharp divergence in experiences of drug users based on race.

For example, in Arizona, fatal drug overdoses among white people decreased by over 2 percent, while among Black people, they surged by roughly one-third. In Michigan, deadly drug overdoses among white people decreased by 12 percent, contrasted with a 6 percent increase among Black individuals. In Maine, fatal overdoses dropped by about 20 percent among white residents, but rose by over 40 percent among Black residents.

In states where both groups experienced decreases, the reductions were typically smaller for Black Americans. Conversely, in states where both groups saw increases, the rise was often more pronounced among Black individuals. Similar disparities were evident in data tracking overdoses among Native and Hispanic Americans.

Experts in drug policy indicate that this new data underscores the uneven application of public health strategies for drug addiction, with fatal consequences. Naloxone, the overdose-reversing medication, has proven harder to access for some Black Americans, as have addiction treatments.

“The question becomes: What are we doing wrong?” said Jennifer Martinez, a researcher at the O’Neill Institute for National and Global Health Law at Georgetown University, who analyzed the findings from public data and records requests. “Why aren’t we designing policies that target the populations that need it the most? Something is working, but it’s not working for the people who need it the most.”

Researchers and health officials pointed to three trends that help explain these disparities.

1. Unequal Access to Treatment:
Drug policy experts note that the state-level findings are partially predictable. Black and white Americans have long experienced differing access to addiction treatments and drug safety tools.

“We know that Black and white people don’t use drugs at different rates,” said Emily Keller, who oversees opioid response efforts in Maryland. “This clearly reflects deeper inequities in our society.”

Dr. Elizabeth Salisbury-Afshar, an addiction expert at the University of Wisconsin, highlighted data indicating that methadone—a tightly controlled treatment often requiring daily visits to specialized clinics—has been more accessible in urban minority communities. However, this treatment remains difficult to obtain for rural minority populations, including Native Americans living on reservations.

Another effective treatment, buprenorphine, which can be dispensed at pharmacies for home use, has been more readily available to white Americans, Dr. Salisbury-Afshar noted.

Overdose deaths among older Black men have been particularly severe, according to Tracie Gardner, a former health official in New York who now leads the Black Harm Reduction Network.

“The addiction field and public health have not focused on older individuals who survived the earlier heroin epidemic or who have consistently used heroin safely,” she said. “Once FYL entered the supply of substances they were already using, that’s what led to their deaths.”

Gardner added that methadone, originally introduced to prevent recidivism, is still viewed by some drug users as an unworthy or undignified medical resource. “Black people are reluctant to embrace methadone because it’s been demonized,” she explained. “Who wants to be known as someone on methadone?”

A bipartisan group of lawmakers in the House and Senate has worked to advance legislation permitting methadone to be prescribed by addiction physicians and dispensed at pharmacies. However, they have faced challenges due in part to intensive lobbying efforts.

“I’m very optimistic that by the end of the year, we will find the right vehicle to get it passed,” said Senator Edward J. Markey, a Massachusetts Democrat and Senate legislation sponsor, in a recent interview.

2. Naloxone Isn’t Always Reaching the Right People:
Health policy experts have hesitated to attribute the national drop in drug overdoses to any single cause. However, one contributing factor is likely the large federal grants that flooded communities with naloxone during the pandemic.

Minority communities have not consistently benefitted from efforts to distribute the medication. In North Carolina last year, free naloxone was distributed more frequently in predominantly white areas than in those with larger Black populations, according to Delesha Carpenter, a health policy researcher at the University of North Carolina conducting federally funded research on naloxone availability.

Just over half of the ZIP codes where Hispanic and Native Americans reside received frequent naloxone distribution, Dr. Carpenter found.

Rachel Winograd, an addiction expert at the University of Missouri, St. Louis, who helps oversee naloxone distribution in Missouri, noted that overdose deaths among Black men in the state fell in 2023 for the first time in years. This change may have been influenced by state officials addressing racial disparities among overdose victims during the pandemic by steering federal grants and opioid settlement funds to community organizations, establishing “depots” for naloxone, she explained.

“People are more likely to use drugs together in densely populated urban areas, which increases the chances of saving lives,” she said, emphasizing the need for infrastructure and dedicated efforts to reach these communities.

3. Data Collection on Overdoses Takes Time:
Researchers have long faced challenges due to the time required for state laboratories to confirm overdose deaths. This delay often hampers efforts to support communities particularly affected by the rise of FYL, stimulants, or the increasingly common sedative XYL.

“It’s a resource issue,” said Robert Anderson, who oversees mortality statistics at the National Center for Health Statistics. “We’re all used to watching ‘CSI’ or ‘NCIS,’ where toxicology results are available in 15 minutes. But that’s not typically the case.”

Anderson noted that many state laboratories processing toxicology reports are overwhelmed by death reports, creating months-long backlogs. “That doesn’t include the time required for autopsies and death scene investigations, which can also take a significant amount of time depending on resources,” he added.

This situation leaves local health workers lagging in their ability to respond to overdose trends in minority communities. Native Americans, who have been disproportionately affected by overdose deaths in recent years, have been particularly impacted by these delays, according to Philomena Kebec, a member of the Bad River Tribe in Wisconsin.

Kebec explained that Native Americans are often misclassified as other races or omitted from overdose data entirely. Of the roughly 10 states from which Georgetown researchers gathered data, many included Black fatality rates but not those for Native Americans.

As someone who helps oversee the state’s mail-order naloxone program, Kebec expressed concern that her tribe lacks access to county-level overdose data broken down by race. “The goal is to interrupt fatality trends for Native Americans and rural populations,” she said. “To evaluate effectiveness, we need a racial breakdown of mortality rates. We’re essentially operating in the dark.”

Keller noted that Maryland has developed a more sophisticated data collection system that tracks overdoses by ZIP code, enabling organizations that assist drug users to tailor their outreach efforts effectively.

Source: The New York Times