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A CDC report finds overdose deaths rose significantly for people of color from 2019 to 2020. The synthetic opioid fentanyl is largely to blame, combined with a disruption in treatment and prevention programs during the pandemic. Dr. Edwin Chapman, who specializes in treating addiction, joins John Yang to discuss.
A new report from the Centers for Disease Control finds us overdose deaths rose significantly for people of color between 2019 and 2020.
As John Yang reports, the CDC says the synthetic opioid fentanyl is largely to blame, combined with other disruptions to treatment and prevention during the pandemic.
Amna, while overall overdose deaths spiked by 30 percent during that period, among Black Americans, the increase was 44 percent, among Native Americans and Alaska Natives, 39 percent. That's compared with a 22 percent increase among white Americans, similar to the rates among Asian Americans and Pacific Islanders and Hispanics.
Dr. Edwin Chapman is a physician in Washington, D.C., who specializes in treating addiction.
Dr. Chapman, thanks for being with us.
We have heard the aggregate numbers. How does that track with what you see in your clinic?
Dr. Edwin Chapman, Addiction Specialist:
Very close to what we're seeing here in Washington, D.C.
We have actually seen a — we saw a 40 percent increase in overdose deaths between 2019 and 2020. And then we saw another 4 or 5 percent increase between '20 and '21. So our overall increase since 2019 has been about 50 percent in the District of Columbia. So those numbers are very close.
And, in your practice, what's driving those numbers? What's driving that increase?
Dr. Edwin Chapman:
So, we have known for some time that our population, which is 95 percent African American, even though, in terms of overdose deaths, even though in the District of Columbia, we account for only 46 percent of the population.
But the difference is that our epidemic started with street Drugs 40, 50, 60 years ago with heroin. But, in 2014, that heroin transitioned to fentanyl. So, we saw 20 percent fentanyl in 2015. And it gradually increased over the next five years to now we're seeing 95 percent fentanyl in our street drugs. And fentanyl is 50 to 100 times more potent than morphine.
And I just want to make sure I'm clear on this.
Is this that drug users are seeking out fentanyl or that the fentanyl is mixed into the street drugs?
Well, it goes both ways.
Initially, it was mixed in. And, subsequently, there were those who did seek out the more potent form. But, unfortunately, with fentanyl being so much stronger than heroin or the typical pills, that people were overdosing and dying.
So we're actually seeing a Darwinian evolution, so to speak. Those who are able to tolerate higher doses of drugs, just by their genetics and by luck, are surviving. And those are the ones that we're seeing in treatment.
Dr. Chapman, are you seeing any other changes in the patients that you're seeing? Is the age, for instance, of your average patient changing?
So, five years ago, we did a survey, and the average age of our patients was about 52, 70 percent male, 30 percent female. We actually — because it's an older population, 10 to 12 percent were testing positive for HIV, and about 50 percent were testing positive for hepatitis C.
So, since that time, the age has increased to an average age of about 60 at the present time.
And what effect does that have on overdose deaths and treatment?
So, again, you're now talking about people who have other chronic diseases, diabetes, hypertension, as well, mixed in with their opioid use and, of course, some of their mental health issues.
Is there — in this sort of racial disparity in the increase, does the access to treatment play a role in this?
Just by structure, African American physicians are only 5 percent, and then, when you look at psychologists, only 4 percent, psychiatrists 2 percent. So we're dealing with those structural issues. And on top of those structural issues, we also have some public policy issues that have to be addressed.
And has the disparity, the widening inequality that we have seen during the pandemic, has that had an effect?
So all of this is really — when we look at it as a whole, we can say that the pandemic really is acting as a barometer for our overall health care system. We can see these structural and public policy issues that have gone for centuries, in fact, coming to the forefront. And they're exacerbated by housing issues, transportation issues.
So, our patient population, because they have been involved in drug use for so many years, are disenfranchised from the community, disenfranchised from family. So we have a very high homeless population.
What are the changes you would like to see that would help you treat your patients?
So, our approach has been really to a team-based approach.
And we realize that 80 percent of the outcomes are related to things outside of the doctor's office, outside of the hospital. So we really need to have this community education. We need to have advocacy in the community, legal support to oversee to make sure that patients are getting the type of treatment that they need.
And, of course, we need to integrate substance abuse, mental health and primary care services, because these patients have the same issues as everyone else. The fact is that they have had so many difficulties, including their involvement with the criminal justice system, that have to be reversed.
Addiction specialist Dr. Edwin Chapman, thank you very much.
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