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Gail Dufault, the Transitional Healthcare Coordinator at the Barnstable County House of Corrections, prepares a dose of Vivitrol at the prison in Buzzards Bay, Massachusetts September 2, 2014. Barnstable is believed to be the first jail in the country to launch an intensive voluntary recovery program for opiate-addicted inmates with the use of Vivitrol, an injectable non-narcotic drug that blocks receptors in the brain and bars addicts from getting high off heroin and other opioids for about 25 days, at a cost of about $1,000 a shot. Picture taken September 2, 2014. To match Feature USA-HEROIN/PRISONS/ REUTERS/Brian Snyder (UNITED STATES - Tags: SOCIETY CRIME LAW DRUGS HEALTH)

How racial inequity is playing out in the opioid crisis

The opioid epidemic in the United States has largely centered on white Americans, who account for roughly 80 percent of opioid overdose victims. But the national attention on white victims has pushed minorities to the sidelines, even as the number of opioid-related deaths among non-whites is on the rise.

Non-whites make up 20 percent of deaths involving prescription and non-prescription opioids in the U.S. According to recent government figures, the number is growing.

And some experts believe the number would be even higher if minorities had the same access to health care as whites — highlighting the complex underlying racial disparities in the U.S. health care system.

Lack of accessibility

Historically and in recent decades, low-income and minority earners have had less access to medical care — an issue now playing out in the opioid crisis.

“Non-Hispanic blacks and Hispanics have had less access than non-Hispanic whites to the health care system through the 1990s and into the early 21st century,” said Ian Rockett, a professor of epidemiology at West Virginia University. The disparity “would lower their probability of being prescribed opioids, and hence their risk for both fatal and non-fatal overdoses.”

According to a 2015 report from the federal Agency for Healthcare and Research Quality, Hispanics had far lower access to general health care than two-thirds of whites. This includes access to health insurance, doctors, and receiving care efficiently and as soon as desired. Socioeconomics and residential location specifically have played a large role in access to care, as poverty status and racial and ethinic identity are often linked. Expansions in Medicaid in numerous states and provisions to health care options through the Affordable Care Act have enhanced access to care. Despite these initiatives, disparities still exist across the board.

As a result, the growth of several minority communities and the need for treatment, highlights an intricate challenge to health care professionals in terms of gaining equal access.

Racial bias and stereotypes

Racial bias and the stereotyping of patients of color also play a role in the rate of prescriptions and overdoses among non-white Americans.

“There is a bias issue there in terms of either believing [minorities are] more likely to be substance abusers or they can endure more pain,” said Kenneth Leonard, the director of the Clinical and Research Institute on Addictions at the University of Buffalo.

Indeed, a large body of research on racial equality in health care shows medical professionals hold falsehoods about the biological contrasts between patients of color and whites. Those viewpoints can perpetuate racial bias in the perception and treatment of non-white patients. These falsehoods can result in discrimination when dealing with pain treatment, with doctors overprescribing medication to whites and under-prescribing to non-whites.

Thomas Womelsdorf, a Prevention Care Manager with the Southern Tier AIDS Program (3rd R), signs attendees up for "Overdose Rescue Kits" during a free Opioid Overdose Prevention Training class provided by Lourdes Hospital in Binghamton, New York, U.S., April 5, 2018. Picture taken April 5, 2018. REUTERS/Andrew Kelly - RC1FBAF09EA0

Attendees sign up for “Overdose Rescue Kits” at a training class in Binghamton, New York, on April 5, 2018. File photo by REUTERS/Andrew Kelly

“There is evidence that overprescription is an issue, but there is also clear evidence that the under-prescription of pain medications for black patients is a real, documented phenomenon,” Rockett said.

Regarding treatment, a 2015 study conducted from over 6,000 emergency departments across the country found significant disparities in prescribing practices, with 22 to 30 percent of patients of color less likely to receive pain relieving medication than their white counterparts.

Racial bias and stereotyping can also lead to mistrust between patients of color and doctors, research shows. Research has also suggested that there’s an indirect correlation between the mistreatment of minorities seeking care based on discrimination, and a willingness for minorities to even get treatment as a result of the discrimination they face. This is particularly the case in African American and Latino communities. These discrepancies can be attributed to lower health care access and lower income. In 2017, the Agency for Healthcare Research and Quality issued its 15th yearly report. Current data available showed that 40 percent of the overall access to efficient health care was worse for blacks than whites, 20 percent of Asian-Americans, 30 percent of Native Americans, and one-third of Pacific Islanders and Hispanics.

Excluded from the conversation

Despite the lower number of fatal overdoses compared to whites, opioids and drug abuse in general is still a rampant problem in many communities of color.

“When you look at 2017, the opioid overdose death rate for white non-Hispanics was 19.4 percent. We’ve seen a doubling of the overdose death rates among blacks” said Jennifer Tolbert, the director of the State Health Reform program at the Kaiser Family Foundation. She added, “I think there is a risk that it’s being somewhat overlooked and overshadowed by the death rates among whites.”

Tolbert referenced data collected from the Substance Abuse and Mental Health Services Administration, which details just how prevalent drug abuse is within numerous communities of color.

Regardless of their race or ethnicity, “increasing numbers of people now will be going straight to heroin and other illicit opioids, whether to relieve pain, get high, or both. Whites have predominated among the high-risk populations during the opioid epidemic, but minorities, especially blacks, now appear to be markedly elevating their risks for opioid use, abuse and death,” said Rockett.

The rising overdose numbers point to a need for better prevention options, said Bertha K. Madras, a psychobiology professor at Harvard Medical School and a member of the White House Commission on Combating Drug Addiction and the Opioid Crisis. In 2017, the commission released 56 recommendations outlining how the nation can reduce opioid overdoses and deaths and ramp up prevention efforts and access to treatment.

“Promoting prevention is a slow process, but reducing the supply can precipitously reduce access to deadly drugs. And we have to maintain this balance between public health and law enforcement with regard to supply,” Madras said.

Last year, President Donald Trump issued a national call to action to end the opioid crisis. Following the declaration, the Trump administration launched an anti-drug campaign to spread awareness about the dangers of abusing opioids. The president also signed a bipartisan bill to combat the opioid crisis.

But Madras and others said government policies often fail to take racial disparities in health care into account.

“I would hope that every human being is treated equally in the health care system,” Madras said. “That is my ideal and that should be the reality.”

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