Increasing death rates from opioid overdoses among whites have been widely documented, but less well-known is the increase in cocaine-related overdoses among blacks, as the National Cancer Institute (NCI) reported last week in the Annals of Internal Medicine. Using complete U.S. death certificate data from the Centers for Disease Control and Prevention’s National Center for Health Statistics, Meredith S. Shiels, Ph.D., and colleagues compared data from 2000–2003 with data from 2012–2015. They found that total overdose death rates increased among blacks (6.1 to 9.0 per 100,000 person years), Hispanics (4.2 to 6.0) and whites (5.6 to 15.5). Broken down by age and race, however, increases were most pronounced for older blacks (men over 50 and women over 45).
The most common contributor to overdose deaths in whites was opioids, but for blacks, cocaine was the largest contributor to overdose. Between 2012 and 2015, cocaine-related overdose deaths were almost as common in black men as deaths due to opioids in white men (7.6 vs. 7.9). Cocaine-related deaths declined between 2008 and 2011, and then increased between 2012 and 2015.
The largest recent increases in drug overdose deaths for blacks and Hispanics were due to heroin, although there were also increases due to other opioids, benzodiazepines and psychostimulants.
The researchers noted that “important public health measures have been initiated, particular in heavily affected areas” in response to opioid deaths among whites. But overdose deaths among blacks and Hispanics “are an important, long-term public health problem that is often overlooked.” Their results are probably underestimates, they said, because about 20 percent of deaths classified as unintentional overdoses miss a contributing drug.
Researchers urged additional research to understand the increasing rates of overdose among older black men and women. In addition, they say it’s essential to focus on preventing cocaine-related deaths, which disproportionately affect older blacks.
Harms of single-drug focus, racial disparity in coverage
The article, “Trends in U.S. Drug Overdose Deaths in Non-Hispanic Black, Hispanic, and Non-Hispanic White Persons, 2000–2015,” underscores two important problems in current drug policy, said H. Westley Clark, M.D., J.D., Dean’s Executive Professor at Santa Clara University: focusing on opioids only, and racial discrimination..
“A single drug focus belies the nature of drug problems,” Clark told ADAW. The Cures Act devoted $1 billion for the opioid epidemic, “but alcohol, cocaine and methamphetamine have been forgotten,” he said. “People dying because of alcohol, cocaine, methamphetamine or any other psychoactive substance are no less important than people dying from opioids.”
The report also brings to light a complaint that many blacks have been making, said Clark. “When African Americans die of drug overdoses, it gets ignored. When whites die of drug overdoses, the whole world listens, from politicians, Big Pharma, researchers and the FDA to the media. When African Americans die, it isn’t news,” he said.
Clark noted that blacks in the public health workforce are “particularly sensitive to the epidemiological reality” that the authors at the NCI, which is part of the National Institutes of Health (NIH), uncovered. “This report demonstrates why African Americans and other people of color in the public health workforce are essential to the public health paradigm,” said Clark. “I commend the NIH researchers for asking the question about race and drugs,” he said. “Their paper provides some of the answers. Now we need to do something. The public health effort should not be to focus on younger whites while ignoring older blacks.”
Much media coverage of opioid overdoses has focused on young white people, many of them in suburbia. The question, said Clark, is why it has taken so long for the disparity in overdose reporting to come to light.
Surgeon general’s report
Clark recommends 2016’s Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health as a framework for a comprehensive strategy that relies on science, prevention, treatment and recovery. Clark, one of the science editors of the report, noted that it “recognizes neurobiologically that psychoactive substance use operates for different people in different ways, but that there is a need for a comprehensive focus.”
The comprehensive strategy recommend by the surgeon general’s report “would allow resources to be used where they are needed,” said Clark. “A population-based prevention strategy would recognize the unique needs of those communities where African Americans live, just as a similar strategy would address the public health needs of the non–African American communities.”
As Congress considers additional funding for substance use issues, it “should look for solutions that address the broader epidemic, not just those aspects of the epidemic that affect white people,” said Clark. “The Congressional Black Caucus and its Health Braintrust should mobilize its colleagues on the Hill to make sure that future legislation addressing drug use includes provisions dealing with the drug use landscape, so that the deaths of African-American drug users due to cocaine are not ignored by public policy.”
For the surgeon general’s report, go to https://addiction.surgeongeneral.gov/.