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Episode 12
ABOUT THE EPISODE:
The world of addiction and treatment are not exempt from the racial disparities we're so painfully aware of at the moment (June, 2020). This episode takes a look at what's happening in Black communities in the U.S. relative to:
- addiction as a percentage of the population vs white and other races
- how the opioid crisis and overdose deaths are impacting the Black community
- misconceptions about opioid prescribing and use
- barriers to gold-standard treatment including MAT
- and strategies to address opioid misuse and improve treatment outcomes
Research for this episode was primarily accessed via SAMHSA's website and publications and can be found in the show notes.
As a white, privileged woman with access to robust medical insurance, resources and support, this was a difficult podcast to record. I pledge to continue to look for areas where I can do better by highlighting areas for improvement and then working to make change in my own work and in the industry.
This episode will give you an initial look at the situation around addiction awareness, prevention and treatment within the Black community. It will be followed by future episodes with guests who can better speak to the day to day realities of a disparate system that prevents POC from accessing the treatment needed to live a life free from addiction.
EPISODE RESOURCES:
- SAMHSA Brief: The Opioid Crisis and the Black/African American Population: An Urgent Issue
- SAMHSA (2018). Results from the 2017 National Survey on Drug Use and Health: Detailed Tables
- Article: 75 Things White People Can Do for Racial Justice by Corinne Shutack
This podcast is part of a nonprofit called Hopestream Community
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Find us on Instagram: @hopestreamcommunity
Download a free e-book, Worried Sick: A Compassionate Guide For Parents When Your Teen or Young Adult Child Misuses Drugs and Alcohol
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Brenda Zane 00:00
Hello and welcome to This week’s episode of hopestream. Today I’ll be doing a solo episode focused on some of the very evident disparities that I have seen in the kind of addiction and treatment world. But not just in treatment, and also the awareness and education pieces of this puzzle. And I wanted to focus on this in light of what’s going on right now, obviously, with the Black Lives Matter movement and all of the attention that is really been placed on lots of different industries, lots of different organizations.
01:42
And I wanted to take a look at what I do and also to take a look at the industry because as odd as that kind of sounds to a lot of people. It is an industry around addiction and treatment. And I started doing research About a week and a half ago, thinking that I would, you know, come up with something and have some great information. And what I have found is really actually very upsetting and disturbing, not only for minority communities but also for people who are not insured or under insured, or who are relying on Medicaid for their insurance. It’s just been incredibly sad and frustrating. I’ve had to go into research mode to to find out what is going on and how this impacts people who are looking for resources for addiction.
02:48
So obviously, as a go into this, and I will be talking a lot about race and I’m really going to be focusing on the Black community in this episode. I will probably We get something wrong, I will probably screw up in some way. And I guess all I can ask for is if you’re listening and I have done that, and you have the energy or the desire, please do call me out and correct me. I’m learning, I am listening. I’m doing all the learning and reading that I can do on my own without having to burden anyone else. But I’m going to get it wrong. So bear with me as I as I do this, and let me know how I can do better. And I promise that I will do that.
03:35
So this will be the first in what I hope to be several podcast episodes on the topic. And that will include specific episodes around insurance, the frustration and battles that we have with insurance companies, but primarily for those who, like I said, are using Medicaid for their insurance, who don’t have insurance. And then also I want to be talking about people who are undocumented here in the US and what their options are. And so they may be spread out these episodes because it takes a ton of research, a lot of phone calls, a lot of not returned phone calls. And so I’m persistent and I will get the information, but just keep listening and hopefully I’ll have some good information to share.
04:27
I’m also solo today because as much as I want input from the Black community on this topic, I don’t want to burden anybody with that right at this very moment. As the as I’m recording this it is mid June and it just didn’t feel right to kind of reach out and put another Ask on somebody’s plate because I know there is just a lot going on and and I don’t want to do that. However, in the future, down the road, I will be bringing on guests who can really get perspective and a better perspective from the Black community. And I guess I would say if you are somebody who could give me some input and would like to be on the show, and you feel like you’ve got the capacity for it, absolutely. Go to the show notes, and get in touch with me, my emails there, I would love love to talk with you. So just know that I’m not going to be sitting here pontificating from just my point of view, I will be bringing people in in the future.
05:32
And so with that, today will be just kind of an overview of the state of, I guess you’d call it the State of the Union. That’s and what I have found in my research, but I wanted to give what I have found so far, with the knowledge that I will be continuing this and expanding on it. And so I want to talk about sort of that overview, the state of substance use and overdose deaths among whites and then among people of color, I want to look at the opioid epidemic in particular and how it is has and is affecting the Black community. And then to talk about some challenges and barriers to treatment that exist. And look at just a couple of options and trends and recommendations from the Black community on how we can do better with treating people in addiction and in with substance use disorder.
06:37
So first of all, what is going on with substance use today. So all of the research that I’m using for this episode will be in the show notes. Most of it comes from SAMHSA and I’ll put links to that in the show notes. And as of 2017, the breakdown looks like this. The population with the highest percentage of substance use disorder is American Indians and Alaska Natives. And that is at 12.8% of the population, which is really, really high and very sad. So they’re at the top of the list with whites following at 7.7%. Blacks/African Americans at 6.8%. And then Hispanics and Latinos at 6.6%, with Asian Americans having the lowest rate of substance use disorder at 3.8%. So big range of difference there between American Indians and Alaska Natives at 12.8% and Asian Americans at 3.8. That’s a pretty wide gap. And if you look at further data from 2018 these are results from the SAMHSA National Survey on Drug Use and Health, you can kind of drill down into the opioid related overdose deaths and deaths involving selected drugs. And you could look at this you can slice and dice this data, a lot of ways. So I’m looking at it from a race and ethnicity standpoint. And the opioid related overdose death rate for the National population increased from 2.9 deaths per 100,000 people in 1999 to 14.9 per 100,000 in 2017. So in 18 years, a jump in overdose deaths from 2.9 to 14.9. And the largest increase in that group of overdose deaths was with synthetic opioids. So we’re not talking about methadone. We’re talking about fentanyl, fentanyl analogs and Tramadol. So that’s huge.
09:01
In 2017, among non-Hispanic Blacks, the opioid related overdose death rate was 12.9 deaths per hundred thousand people. And that is the third highest opioid related overdose death rate when you compare it to other races and ethnicities, and synthetic opioids are really what’s contributing to that rise in overdose deaths, and again, those are fentanyl analogues and Tramadol and they are affecting the non Hispanic Black community more severely than any other population. In 2017, non Hispanic Blacks had the highest percentage of opioid overdose deaths and total drug deaths as a whole attributed to synthetic opioids. So this is really important to recognize that fentanyl and fentanyl analogues so this is car fentanyl and there’s a few others Tramadol are being manufactured illicitly being shipped into the US illegally, and then being cut into all kinds of street drugs. So the penetration of fentanyl is pretty much 100% at this point. And those accounts, those synthetic opioids accounted for almost 70% of the opioid related overdose deaths, and 43% of the total overdose drug deaths for Blacks in 2017. These numbers are so staggering and so huge that you almost want to double check the research because it’s just so so unbelievable to see. And then this last statistic is is probably the most shocking of all, and that is that from in just three years from 2014 to 2017 Among these synthetic opioids, the death rate involving synthetic opioids increased 818% among non Hispanic Blacks, and that is the highest compared to all other races and nationalities. So again in three years, a rise of 818%. That is just unacceptable. And it’s it’s a statistic that I think needs to be talked about more,
11:36
I think, potentially we are all on overwhelm and overload when it comes to health data right now, especially with COVID-19. But these numbers should not just be put on the back burner and not swept away. These are really shocking and disturbing numbers that we need to pay attention to. And you know, in the media the opioid epidemic has really primarily focused on white, suburban and rural communities. And there just hasn’t been as much attention focused on the Black community. And they’re experiencing similar dramatic increases in misuse. And as we just learned in a significant increase in overdose deaths, in 1971, the quote unquote War on Drugs began. And that resulted in widespread incarcerate incarceration of drug users and disruption of primarily Black families and communities. And the Black population was criminalized for drug related offenses at way higher rates than white Americans. And this has really had lasting effects until today still present today.
12:53
And in 2017, even though Blacks represented roughly 12% of the US adult population, they made up for over 30% of the sentence to prison population. And in the last data I could find from 2012 was that Blacks made up 39% of the population incarcerated for drug related offenses. So you can see that the disparity there is, is enormous. When you look at the percentage of population and the percentage of incarceration for drug offenses. If you look at the history of incarceration, and you look at the current overdose situation, you have to ask what is going on?
13:38
And, and part of that is looking at the path to substance use and misuse and really diving into some of the data. You know, there there’s sort of the typical story and scenario that we see where a common route to opioid misuse and overdose is because of excessive prescribing Use of opioids, that typically leads to a transition to use of heroin because it’s cheaper and more accessible. And then another route is directly through heroin and cocaine, illicit heroin and cocaine. And both of those, you know, have a long history in low income Black communities. And that dates, you know, back to the 60s and 70s. And now you have not just straight heroin and cocaine, you’ve got heroin and cocaine laced with fentanyl. And so what previously would not have been a lethal dose, it would be a problematic dose, but not a lethal dose becomes lethal without the person even knowing it.
14:44
And interestingly, when it comes to prescription opioids, there’s been this sort of idea proposed that the Black community might be more insulated from the fast rising rates of opioid misuse and overdose because of a lack of access to the medication. So this is sort of rooted in misperceptions and biases in the healthcare system that undervalues Black individuals reports of pain and stereotyping by the providers. And there was a study that was done that found that Blacks are significantly less likely to be prescribed opioids for pain from a medical provider than a white patient is. And when you compare whites to Blacks with prescribed opioids, Black patients were 29% less likely to be prescribed opioids for their pain. And this is due to a couple of reasons.
15:39
One is just a lack of communication and misinterpretations about the pain with the medical provider. And the studies showed that Black patients have a higher self reported pain scores when it when they’re compared with whites. Yet, doctors choose to believe that the pain levels are should be similar or should be lower for Blacks compared to whites. And there’s also a perception on behalf of the physician that Blacks were drug seekers. So, in a very odd way that might sound good in that there would be less opioid prescribing going on to the Black community. But there are a couple of pretty negative outcomes from that. Obviously, one is a myth that Blacks are being protected from the opioid crisis when clearly they aren’t. And also, there’s a huge potential for under or miss treatment of pain for Black patients who have severely painful medical conditions. Like sickle cell disease, there are certain cancers and HIV/AIDS and autoimmune diseases that are extremely painful. So this was also very upsetting to see the fact that there’s a population of people who have, you know, legitimate pain, and are trying to communicate that to their physician and are not being heard and are being under prescribed medications that they may very well need.
17:14
So that is a very, very brief look at what is going on. Again, this could be a four hour episode in itself. But I wanted to get on to sort of what some of the barriers to treatment are. And these are pretty wide ranging and very interesting. Again, these are are pulled from the SAMHSA report that will be in the show notes. And I am just distilling these down to the very, very basics of that, but you’re welcome to download and read the whole report if you want to.
17:48
So one of the barriers to treatment are stereotypes and stigma. And so as we all know, if you have substance use disorder to begin with, you’re going to be stereotyped, and you’re going to Feel a huge amount of stigma. If you’re Black and you have substance use disorder, you are doubly stigmatized, just from the get go, which we know makes it even harder to access help for your situation. And statistically, you’re also more likely to be mistreated and discriminated against and even kind of punished for your disease, instead of being offered treatment, compassion and recovery services. So right out of the gate, you’re already at a disadvantage for getting the treatment that you need.
18:33
There’s also an issue of intergenerational substance use for a certain percentage of the population. And substance use is often passed down from generation to generation and in communities with high poverty and economic disinvestment, this is even more common. And so for many in poor and low income communities, using and selling drugs is really a means of selling survival. This is this is passed down from generation to generation. And it means that drug use isn’t necessarily looked at as a problem to be solved or doesn’t get the same response or reaction from parents. Because this is something that is that is a family issue. And so it would really require somebody to kind of disentangle themselves from their entire social network, and their family, family relationships, if they decided to go and get help and get treatment. There’s just a huge burden there. If you think about what that means to somebody who’s potentially wanting to change their life and get help, to have to sever those ties or to make a change, that is that is so radical would be a very large barrier.
19:56
And there’s also a fear of legal consequences in the US general population, only about 10% of people with substance use disorder seek treatment. And this is magnified in the Black community where there’s already a historical mistrust of the healthcare system of social services and the justice system. And because of the past focus on incarceration that started with the war on drugs in the 70s. Men in particular are afraid that seeking treatment could end them up in jail. And Black women fear that they may lose their kids to the foster care system if they acknowledge a substance use problem and go to seek treatment. So this fear of the legal consequences of getting helpful for yourself medical help is just shows how bad our system is set up for helping people get the treatment that they need.
20:53
The studies also showed that there are some misconceptions about addiction and treatment options. So in general society has sort of a lack of understanding about substance use disorder, about it being a disease. And this is especially true in the Black community, it’s more common to be seen or looked at as a weakness, or a moral failing and not being looked at as an actual disease. And there’s also a misperception and lack of understanding of the treatment options. And this is especially true around medication assisted treatment, which is the current gold standard and really reduces the overall chances of relapse. You know, if you have a misperception about medication assisted treatment, or MAT, as I’ll refer to it, that is going to lower your chances overall of somebody seeking out these really, truly evidence based options. So, there’s a misperception that using MAT, which the drugs included in that category are methadone, buprenorphine or Naltrexone, you might also hear it called be called Vivitrol, which is the brand name. There’s a perception that if you’re using one of those, that you’re just trading one drug for another, that you’re still using drugs, and that this is really not how the industry see that these drugs are really considered to be the gold standard treatment path.
22:24
And this this misperception is especially true for methadone, which is kind of viewed as the default treatment for for Black people with substance use disorder. And there’s, there’s a whole podcast episode I could do that around methadone, and I actually have somebody that I’m going to be talking to about that very, very interesting history around methadone and buprenorphine and the racial disparities, both in the accessibility and the use of those two drugs. So watch for watch for that coming. There’s also a lack of culturally responsive and respectful care. So in general, it can be hard to see people as more than their addiction just in general. And then this is even more amplified for a Black person with substance use disorder, because they are already subjected to biases from the healthcare system. So that is amplified by a shortage of physicians of color in general. And especially if you go even more narrow if you’re looking for a physician of color who can prescribe buprenorphine. So one of these gold standard medication assisted treatments, it is like looking for a needle in a haystack. So it’s going to be incredibly hard for a Black patient to find a provider who is culturally similar and responsive and respectful for them. So that already just cuts down the opportunity for getting the treatment that’s needed.
24:03
There’s also really separate and unequal prevention, overall prevention messages and treatment. And so unequal treatment is really common in many Black and African American communities where access to treatment is really dependent, more dependent on your race, your income, your geography and your insurance status. And as of 2018 34% of black individuals in the US have Medicaid as their health insurance, which I have found out over the last couple of weeks of research severely limits your access to treatment, and especially for MAT. Meaning buprenorphine, also known as Suboxone and Vivitrol. Now access to methadone is a little bit easier for those with Medicaid. It is more accessible physically, but the physical accessibility of it is in clinics that are usually not in very desirable locations. And it also means that somebody has to go to the clinic each day to get their methadone, which is not convenient for a lot of people’s schedules.
25:19
And when you think about medication assisted treatment, it should be as accessible as going to your primary care provider to your doctor’s office once a week or once a month, and being able to live your life. And that is just not the case right now, especially if you are on Medicaid. There was a study that was based in New York City that found the resident and residential area with the highest proportion of Black and African American and Latino low income individuals also had the highest methadone treatment rate, while buprenorphine and Naloxone which are the other Suboxone and Vivitrol, were more accessible in residential areas with the greatest proportion of white, high income patients. So this was documented in a research study and a well known fact for many, many people who are trying to seek that treatment.
26:17
And among individuals with opioid use disorder, Black Americans in the US were less likely to receive buprenorphine compared to whites and those who self pay or had private insurance. So people who are just paying straight out of their pocket or they’ve got insurance through their company represented almost 74% of the people who got buprenorphine, and this was between 2012 and 2015. So that’s just a staggering statistic right there. 74%. So that means if you’re on Medicaid, you’re going to have big challenges in accessing treatment through medication assisted treatment. And the reason why I focus on this is because buprenorphine or Suboxone is, is generally a less stigmatizing treatment for people with substance use disorder compared to methadone. So if you’re getting buprenorphine, it’s an office space treatment, you can go to your primary care physician, if they are licensed to prescribe it and get a shot either once a week, like I said, once a month, there’s also injectables, there’s lots of options for getting this. And these office based treatment programs only work for patients with access to a primary care physician in an area that is accessible to them. And so this this is just a big barrier that needs to be addressed and the access the fact that the medications are available, and they are covered by Medicaid, but are not accessible is something that really needs to be addressed.
28:03
Okay, so those were a few of the many – and I’m sure there are many, many more that I am not mentioning here are some of the barriers to people getting treatment when they actually want to, to deal with their substance use disorder. So we’ll transition to talking about some of the strategies to address opioid misuse, and opioid use disorder in Black and African American communities. Again, these are from the SAMHSA research. And, again, I will probably get some of this wrong. So I apologize. I’m doing my best to bring the information forth from the study that did have input from the Black community and I would love to know where I go wrong on this. But in reading this material and doing a lot of research in It really shows that African Americans do have a lower rate of recovery from drug addiction following treatment. So that is a documented statistic.
29:12
And you can speculate, you know that opioids are a way of coping with, you know, life and in the absence of a healing community, in a community that’s been traumatized by decades of violence and poverty and neglect, and you add a, you know, a significant percentage of people who are living under the poverty level, even though they’re working full time, they’re just not able to make a decent living, there’s a sense of hopelessness that can build and that can temporarily be fixed by opioids or other other drugs. So the solution obviously has to go beyond just getting people into treatment. So you can get people into treatment that might solve the physiological reasons for addiction. But it needs to really involve an entire community to come to a solution that will support a person after they come out of treatment. And so some of the recommendations for creating community informed options to support people around education and treatment, start with the community. And so providing a comprehensive, holistic approach, rather than sort of piecemeal one off approaches.
30:36
And one of the people that contributed to this study, put it in a way that I thought was was really great. So I’m just going to read the quote, “There’s so much evidence that addiction is beyond the neuro receptor level. It’s the criminal justice system, daily life in the neighborhood all have an impact on outcomes in addiction treatment. medication is essential, but not a magic bullet for treating opioid use disorders, you need more to recover successfully, not a single method that sustains recovery on its own, especially for those living in toxic environments. Rather, a comprehensive holistic approach tailored to the community is required. for African Americans addiction is embedded in a community context marked by limited opportunity, economic disinvestment, violence, and intergenerational trauma. Research has confirmed that strong neighborhood cohesion and social ties are correlated with lower drug rates and related consequences.” I thought that was so well put and so real. So that was a really interesting viewpoint into a truly holistic solution versus getting somebody into treatment and calling it a day and hoping that everything works when they get out.
31:54
And in a population that’s been mistreated and marginalized by the traditional systems. There’s a need to reach into the community and really understand what are what are the assets that exist there that can help with education, with prevention, and with moving people toward treatment options. And in some communities, you know, that might look like the barber shop, or that might look like a place of worship versus a medical clinic. And it might mean using the indigenous leaders within that community and other people who have already been through it and are in recovery, to spread education about Narcan instead of the police. So it’s really looking at how can we make this a community based effort versus something that’s coming from a system that has already been beating people down and are it’s filled with mistrust to start out with, we also need to increase culturally relevant public awareness.
32:55
So input for this study again said it best, “campaigns are whitewashed and make no sense in Black communities.” And when the opioid epidemic was deemed a national health emergency in 2018, it spurred media campaigns, it spurred social media campaigns that really left the Black community saying, “where are all the Black people?” And those campaigns didn’t use language that’s culturally appropriate to the community, the educational materials were not culturally appropriate. And, you know, there’s one way to ensure that somebody doesn’t get information, it’s to not even include them in the conversation. So the culturally relevant awareness needs to happen and needs to be considered more when creating these materials.
33:46
There’s also a need for culturally specific engagement strategies that really need to be made available and that, you know, this can look like support groups that are not just inclusive have Black people but created by and for the Black community. Just trying to cookie cutter on what works for another group of people is likely not going to work for this community. And there’s you know, ideas about making use of faith leaders and trust, make them trusted messengers and let them link those faith communities and opioid prevention and education and treatment. You know, they already know their communities, they know how to talk to them. They have already been tapped into in the past for other health related conversations. So they’re really well positioned to have that conversation in that dialogue and promote awareness and education in a way that will resonate.
34:47
And people also need to have programs in place that are easily accessible to them. So there have been numerous studies that have found that a lack of transportation is one of the top barriers to treatment for African Americans. So if you can’t even get to your group, there is a higher chance that you are not going to sustain your treatment program.
35:12
And we also need a culturally relevant and diverse workforce in the treatment industry. When Black and African Americans make the difficult decision to enter treatment, and it is difficult for everybody, but but when when you do make that decision, if you don’t see any staff at the treatment facility that you’re going to, and nobody that you see shares a similar cultural background with you. It’s a huge barrier to, to stay in there, to being engaged in that program, to connecting with somebody who understands where you’re coming from, what issues you are dealing with, and just overall building a connection there. And then, of course, as I mentioned previously, Another big area in the workforce that is unequal and hinders the Black populations. accessibility to treatment is in the physicians of color and physicians, including mental health professionals, but especially physicians who are licensed to prescribe medication assisted treatment.
36:25
So where do we go with all of this? Again, I am sharing this as a start as a beginning to exploring what I think more people need to know and understand including myself. And I hope that by speaking up and perfectly taking some imperfect action, rather than doing nothing, that I will find some other people who are willing to engage in this conversation who are willing to see what we can do.
36:59
As a white, privileged female, I can’t just sit and not do anything. And so I will be leaning on the others in this industry, who are more educated than me in this topic to help me to be better and to see what I can do in the areas of awareness and prevention and treatment. Obviously, I don’t own a treatment center or anything like that. But I do feel like my background in marketing advertising could be something that could be put to use. So thank you for letting me stumble through this. Know that I am working to do what I can do and I really encourage you to reach out to me if you are a person who could help help me understand to help others in the industry understand how we can do a better job of actually providing access and treat education and awareness around substance use disorder for the Black community in a way that is helpful and respectful and will actually make a difference.
38:13
Thank you so much for listening, and I look forward to having you back next week. There will also be a special bonus Father’s Day episode coming out on Sunday, on June 21st to celebrate dads out there, it’s an incredibly emotional and fascinating episode that I think you’ll really enjoy. And be sure to pass it along to any man any guy who is struggling with a spouse, a wife or a partner who is dealing with addiction. So that’s a sneak preview for you.
38:49
And as always, I would love your review and your rating. It just helps to bump hope stream up a little bit further in the vast sea of podcasts out there.
39:01
And if you’re a mom who is going through this with your child who is battling substance use disorder, please visit Brendazane.com/thestream. I’ll put that in the show notes as well. That’s our online community built for you created for you to give you support while you need it from other moms who have been in your shoes and who get it, get what it’s like. So I would love to have you join us there. And until then, I will see you back here next week.
Hello and welcome to This week’s episode of hopestream. Today I’ll be doing a solo episode focused on some of the very evident disparities that I have seen in the kind of addiction and treatment world. But not just in treatment, and also the awareness and education pieces of this puzzle. And I wanted to focus on this in light of what’s going on right now, obviously, with the Black Lives Matter movement and all of the attention that is really been placed on lots of different industries, lots of different organizations.
01:42
And I wanted to take a look at what I do and also to take a look at the industry because as odd as that kind of sounds to a lot of people. It is an industry around addiction and treatment. And I started doing research About a week and a half ago, thinking that I would, you know, come up with something and have some great information. And what I have found is really actually very upsetting and disturbing, not only for minority communities but also for people who are not insured or under insured, or who are relying on Medicaid for their insurance. It’s just been incredibly sad and frustrating. I’ve had to go into research mode to to find out what is going on and how this impacts people who are looking for resources for addiction.
02:48
So obviously, as a go into this, and I will be talking a lot about race and I’m really going to be focusing on the Black community in this episode. I will probably We get something wrong, I will probably screw up in some way. And I guess all I can ask for is if you’re listening and I have done that, and you have the energy or the desire, please do call me out and correct me. I’m learning, I am listening. I’m doing all the learning and reading that I can do on my own without having to burden anyone else. But I’m going to get it wrong. So bear with me as I as I do this, and let me know how I can do better. And I promise that I will do that.
03:35
So this will be the first in what I hope to be several podcast episodes on the topic. And that will include specific episodes around insurance, the frustration and battles that we have with insurance companies, but primarily for those who, like I said, are using Medicaid for their insurance, who don’t have insurance. And then also I want to be talking about people who are undocumented here in the US and what their options are. And so they may be spread out these episodes because it takes a ton of research, a lot of phone calls, a lot of not returned phone calls. And so I’m persistent and I will get the information, but just keep listening and hopefully I’ll have some good information to share.
04:27
I’m also solo today because as much as I want input from the Black community on this topic, I don’t want to burden anybody with that right at this very moment. As the as I’m recording this it is mid June and it just didn’t feel right to kind of reach out and put another Ask on somebody’s plate because I know there is just a lot going on and and I don’t want to do that. However, in the future, down the road, I will be bringing on guests who can really get perspective and a better perspective from the Black community. And I guess I would say if you are somebody who could give me some input and would like to be on the show, and you feel like you’ve got the capacity for it, absolutely. Go to the show notes, and get in touch with me, my emails there, I would love love to talk with you. So just know that I’m not going to be sitting here pontificating from just my point of view, I will be bringing people in in the future.
05:32
And so with that, today will be just kind of an overview of the state of, I guess you’d call it the State of the Union. That’s and what I have found in my research, but I wanted to give what I have found so far, with the knowledge that I will be continuing this and expanding on it. And so I want to talk about sort of that overview, the state of substance use and overdose deaths among whites and then among people of color, I want to look at the opioid epidemic in particular and how it is has and is affecting the Black community. And then to talk about some challenges and barriers to treatment that exist. And look at just a couple of options and trends and recommendations from the Black community on how we can do better with treating people in addiction and in with substance use disorder.
06:37
So first of all, what is going on with substance use today. So all of the research that I’m using for this episode will be in the show notes. Most of it comes from SAMHSA and I’ll put links to that in the show notes. And as of 2017, the breakdown looks like this. The population with the highest percentage of substance use disorder is American Indians and Alaska Natives. And that is at 12.8% of the population, which is really, really high and very sad. So they’re at the top of the list with whites following at 7.7%. Blacks/African Americans at 6.8%. And then Hispanics and Latinos at 6.6%, with Asian Americans having the lowest rate of substance use disorder at 3.8%. So big range of difference there between American Indians and Alaska Natives at 12.8% and Asian Americans at 3.8. That’s a pretty wide gap. And if you look at further data from 2018 these are results from the SAMHSA National Survey on Drug Use and Health, you can kind of drill down into the opioid related overdose deaths and deaths involving selected drugs. And you could look at this you can slice and dice this data, a lot of ways. So I’m looking at it from a race and ethnicity standpoint. And the opioid related overdose death rate for the National population increased from 2.9 deaths per 100,000 people in 1999 to 14.9 per 100,000 in 2017. So in 18 years, a jump in overdose deaths from 2.9 to 14.9. And the largest increase in that group of overdose deaths was with synthetic opioids. So we’re not talking about methadone. We’re talking about fentanyl, fentanyl analogs and Tramadol. So that’s huge.
09:01
In 2017, among non-Hispanic Blacks, the opioid related overdose death rate was 12.9 deaths per hundred thousand people. And that is the third highest opioid related overdose death rate when you compare it to other races and ethnicities, and synthetic opioids are really what’s contributing to that rise in overdose deaths, and again, those are fentanyl analogues and Tramadol and they are affecting the non Hispanic Black community more severely than any other population. In 2017, non Hispanic Blacks had the highest percentage of opioid overdose deaths and total drug deaths as a whole attributed to synthetic opioids. So this is really important to recognize that fentanyl and fentanyl analogues so this is car fentanyl and there’s a few others Tramadol are being manufactured illicitly being shipped into the US illegally, and then being cut into all kinds of street drugs. So the penetration of fentanyl is pretty much 100% at this point. And those accounts, those synthetic opioids accounted for almost 70% of the opioid related overdose deaths, and 43% of the total overdose drug deaths for Blacks in 2017. These numbers are so staggering and so huge that you almost want to double check the research because it’s just so so unbelievable to see. And then this last statistic is is probably the most shocking of all, and that is that from in just three years from 2014 to 2017 Among these synthetic opioids, the death rate involving synthetic opioids increased 818% among non Hispanic Blacks, and that is the highest compared to all other races and nationalities. So again in three years, a rise of 818%. That is just unacceptable. And it’s it’s a statistic that I think needs to be talked about more,
11:36
I think, potentially we are all on overwhelm and overload when it comes to health data right now, especially with COVID-19. But these numbers should not just be put on the back burner and not swept away. These are really shocking and disturbing numbers that we need to pay attention to. And you know, in the media the opioid epidemic has really primarily focused on white, suburban and rural communities. And there just hasn’t been as much attention focused on the Black community. And they’re experiencing similar dramatic increases in misuse. And as we just learned in a significant increase in overdose deaths, in 1971, the quote unquote War on Drugs began. And that resulted in widespread incarcerate incarceration of drug users and disruption of primarily Black families and communities. And the Black population was criminalized for drug related offenses at way higher rates than white Americans. And this has really had lasting effects until today still present today.
12:53
And in 2017, even though Blacks represented roughly 12% of the US adult population, they made up for over 30% of the sentence to prison population. And in the last data I could find from 2012 was that Blacks made up 39% of the population incarcerated for drug related offenses. So you can see that the disparity there is, is enormous. When you look at the percentage of population and the percentage of incarceration for drug offenses. If you look at the history of incarceration, and you look at the current overdose situation, you have to ask what is going on?
13:38
And, and part of that is looking at the path to substance use and misuse and really diving into some of the data. You know, there there’s sort of the typical story and scenario that we see where a common route to opioid misuse and overdose is because of excessive prescribing Use of opioids, that typically leads to a transition to use of heroin because it’s cheaper and more accessible. And then another route is directly through heroin and cocaine, illicit heroin and cocaine. And both of those, you know, have a long history in low income Black communities. And that dates, you know, back to the 60s and 70s. And now you have not just straight heroin and cocaine, you’ve got heroin and cocaine laced with fentanyl. And so what previously would not have been a lethal dose, it would be a problematic dose, but not a lethal dose becomes lethal without the person even knowing it.
14:44
And interestingly, when it comes to prescription opioids, there’s been this sort of idea proposed that the Black community might be more insulated from the fast rising rates of opioid misuse and overdose because of a lack of access to the medication. So this is sort of rooted in misperceptions and biases in the healthcare system that undervalues Black individuals reports of pain and stereotyping by the providers. And there was a study that was done that found that Blacks are significantly less likely to be prescribed opioids for pain from a medical provider than a white patient is. And when you compare whites to Blacks with prescribed opioids, Black patients were 29% less likely to be prescribed opioids for their pain. And this is due to a couple of reasons.
15:39
One is just a lack of communication and misinterpretations about the pain with the medical provider. And the studies showed that Black patients have a higher self reported pain scores when it when they’re compared with whites. Yet, doctors choose to believe that the pain levels are should be similar or should be lower for Blacks compared to whites. And there’s also a perception on behalf of the physician that Blacks were drug seekers. So, in a very odd way that might sound good in that there would be less opioid prescribing going on to the Black community. But there are a couple of pretty negative outcomes from that. Obviously, one is a myth that Blacks are being protected from the opioid crisis when clearly they aren’t. And also, there’s a huge potential for under or miss treatment of pain for Black patients who have severely painful medical conditions. Like sickle cell disease, there are certain cancers and HIV/AIDS and autoimmune diseases that are extremely painful. So this was also very upsetting to see the fact that there’s a population of people who have, you know, legitimate pain, and are trying to communicate that to their physician and are not being heard and are being under prescribed medications that they may very well need.
17:14
So that is a very, very brief look at what is going on. Again, this could be a four hour episode in itself. But I wanted to get on to sort of what some of the barriers to treatment are. And these are pretty wide ranging and very interesting. Again, these are are pulled from the SAMHSA report that will be in the show notes. And I am just distilling these down to the very, very basics of that, but you’re welcome to download and read the whole report if you want to.
17:48
So one of the barriers to treatment are stereotypes and stigma. And so as we all know, if you have substance use disorder to begin with, you’re going to be stereotyped, and you’re going to Feel a huge amount of stigma. If you’re Black and you have substance use disorder, you are doubly stigmatized, just from the get go, which we know makes it even harder to access help for your situation. And statistically, you’re also more likely to be mistreated and discriminated against and even kind of punished for your disease, instead of being offered treatment, compassion and recovery services. So right out of the gate, you’re already at a disadvantage for getting the treatment that you need.
18:33
There’s also an issue of intergenerational substance use for a certain percentage of the population. And substance use is often passed down from generation to generation and in communities with high poverty and economic disinvestment, this is even more common. And so for many in poor and low income communities, using and selling drugs is really a means of selling survival. This is this is passed down from generation to generation. And it means that drug use isn’t necessarily looked at as a problem to be solved or doesn’t get the same response or reaction from parents. Because this is something that is that is a family issue. And so it would really require somebody to kind of disentangle themselves from their entire social network, and their family, family relationships, if they decided to go and get help and get treatment. There’s just a huge burden there. If you think about what that means to somebody who’s potentially wanting to change their life and get help, to have to sever those ties or to make a change, that is that is so radical would be a very large barrier.
19:56
And there’s also a fear of legal consequences in the US general population, only about 10% of people with substance use disorder seek treatment. And this is magnified in the Black community where there’s already a historical mistrust of the healthcare system of social services and the justice system. And because of the past focus on incarceration that started with the war on drugs in the 70s. Men in particular are afraid that seeking treatment could end them up in jail. And Black women fear that they may lose their kids to the foster care system if they acknowledge a substance use problem and go to seek treatment. So this fear of the legal consequences of getting helpful for yourself medical help is just shows how bad our system is set up for helping people get the treatment that they need.
20:53
The studies also showed that there are some misconceptions about addiction and treatment options. So in general society has sort of a lack of understanding about substance use disorder, about it being a disease. And this is especially true in the Black community, it’s more common to be seen or looked at as a weakness, or a moral failing and not being looked at as an actual disease. And there’s also a misperception and lack of understanding of the treatment options. And this is especially true around medication assisted treatment, which is the current gold standard and really reduces the overall chances of relapse. You know, if you have a misperception about medication assisted treatment, or MAT, as I’ll refer to it, that is going to lower your chances overall of somebody seeking out these really, truly evidence based options. So, there’s a misperception that using MAT, which the drugs included in that category are methadone, buprenorphine or Naltrexone, you might also hear it called be called Vivitrol, which is the brand name. There’s a perception that if you’re using one of those, that you’re just trading one drug for another, that you’re still using drugs, and that this is really not how the industry see that these drugs are really considered to be the gold standard treatment path.
22:24
And this this misperception is especially true for methadone, which is kind of viewed as the default treatment for for Black people with substance use disorder. And there’s, there’s a whole podcast episode I could do that around methadone, and I actually have somebody that I’m going to be talking to about that very, very interesting history around methadone and buprenorphine and the racial disparities, both in the accessibility and the use of those two drugs. So watch for watch for that coming. There’s also a lack of culturally responsive and respectful care. So in general, it can be hard to see people as more than their addiction just in general. And then this is even more amplified for a Black person with substance use disorder, because they are already subjected to biases from the healthcare system. So that is amplified by a shortage of physicians of color in general. And especially if you go even more narrow if you’re looking for a physician of color who can prescribe buprenorphine. So one of these gold standard medication assisted treatments, it is like looking for a needle in a haystack. So it’s going to be incredibly hard for a Black patient to find a provider who is culturally similar and responsive and respectful for them. So that already just cuts down the opportunity for getting the treatment that’s needed.
24:03
There’s also really separate and unequal prevention, overall prevention messages and treatment. And so unequal treatment is really common in many Black and African American communities where access to treatment is really dependent, more dependent on your race, your income, your geography and your insurance status. And as of 2018 34% of black individuals in the US have Medicaid as their health insurance, which I have found out over the last couple of weeks of research severely limits your access to treatment, and especially for MAT. Meaning buprenorphine, also known as Suboxone and Vivitrol. Now access to methadone is a little bit easier for those with Medicaid. It is more accessible physically, but the physical accessibility of it is in clinics that are usually not in very desirable locations. And it also means that somebody has to go to the clinic each day to get their methadone, which is not convenient for a lot of people’s schedules.
25:19
And when you think about medication assisted treatment, it should be as accessible as going to your primary care provider to your doctor’s office once a week or once a month, and being able to live your life. And that is just not the case right now, especially if you are on Medicaid. There was a study that was based in New York City that found the resident and residential area with the highest proportion of Black and African American and Latino low income individuals also had the highest methadone treatment rate, while buprenorphine and Naloxone which are the other Suboxone and Vivitrol, were more accessible in residential areas with the greatest proportion of white, high income patients. So this was documented in a research study and a well known fact for many, many people who are trying to seek that treatment.
26:17
And among individuals with opioid use disorder, Black Americans in the US were less likely to receive buprenorphine compared to whites and those who self pay or had private insurance. So people who are just paying straight out of their pocket or they’ve got insurance through their company represented almost 74% of the people who got buprenorphine, and this was between 2012 and 2015. So that’s just a staggering statistic right there. 74%. So that means if you’re on Medicaid, you’re going to have big challenges in accessing treatment through medication assisted treatment. And the reason why I focus on this is because buprenorphine or Suboxone is, is generally a less stigmatizing treatment for people with substance use disorder compared to methadone. So if you’re getting buprenorphine, it’s an office space treatment, you can go to your primary care physician, if they are licensed to prescribe it and get a shot either once a week, like I said, once a month, there’s also injectables, there’s lots of options for getting this. And these office based treatment programs only work for patients with access to a primary care physician in an area that is accessible to them. And so this this is just a big barrier that needs to be addressed and the access the fact that the medications are available, and they are covered by Medicaid, but are not accessible is something that really needs to be addressed.
28:03
Okay, so those were a few of the many – and I’m sure there are many, many more that I am not mentioning here are some of the barriers to people getting treatment when they actually want to, to deal with their substance use disorder. So we’ll transition to talking about some of the strategies to address opioid misuse, and opioid use disorder in Black and African American communities. Again, these are from the SAMHSA research. And, again, I will probably get some of this wrong. So I apologize. I’m doing my best to bring the information forth from the study that did have input from the Black community and I would love to know where I go wrong on this. But in reading this material and doing a lot of research in It really shows that African Americans do have a lower rate of recovery from drug addiction following treatment. So that is a documented statistic.
29:12
And you can speculate, you know that opioids are a way of coping with, you know, life and in the absence of a healing community, in a community that’s been traumatized by decades of violence and poverty and neglect, and you add a, you know, a significant percentage of people who are living under the poverty level, even though they’re working full time, they’re just not able to make a decent living, there’s a sense of hopelessness that can build and that can temporarily be fixed by opioids or other other drugs. So the solution obviously has to go beyond just getting people into treatment. So you can get people into treatment that might solve the physiological reasons for addiction. But it needs to really involve an entire community to come to a solution that will support a person after they come out of treatment. And so some of the recommendations for creating community informed options to support people around education and treatment, start with the community. And so providing a comprehensive, holistic approach, rather than sort of piecemeal one off approaches.
30:36
And one of the people that contributed to this study, put it in a way that I thought was was really great. So I’m just going to read the quote, “There’s so much evidence that addiction is beyond the neuro receptor level. It’s the criminal justice system, daily life in the neighborhood all have an impact on outcomes in addiction treatment. medication is essential, but not a magic bullet for treating opioid use disorders, you need more to recover successfully, not a single method that sustains recovery on its own, especially for those living in toxic environments. Rather, a comprehensive holistic approach tailored to the community is required. for African Americans addiction is embedded in a community context marked by limited opportunity, economic disinvestment, violence, and intergenerational trauma. Research has confirmed that strong neighborhood cohesion and social ties are correlated with lower drug rates and related consequences.” I thought that was so well put and so real. So that was a really interesting viewpoint into a truly holistic solution versus getting somebody into treatment and calling it a day and hoping that everything works when they get out.
31:54
And in a population that’s been mistreated and marginalized by the traditional systems. There’s a need to reach into the community and really understand what are what are the assets that exist there that can help with education, with prevention, and with moving people toward treatment options. And in some communities, you know, that might look like the barber shop, or that might look like a place of worship versus a medical clinic. And it might mean using the indigenous leaders within that community and other people who have already been through it and are in recovery, to spread education about Narcan instead of the police. So it’s really looking at how can we make this a community based effort versus something that’s coming from a system that has already been beating people down and are it’s filled with mistrust to start out with, we also need to increase culturally relevant public awareness.
32:55
So input for this study again said it best, “campaigns are whitewashed and make no sense in Black communities.” And when the opioid epidemic was deemed a national health emergency in 2018, it spurred media campaigns, it spurred social media campaigns that really left the Black community saying, “where are all the Black people?” And those campaigns didn’t use language that’s culturally appropriate to the community, the educational materials were not culturally appropriate. And, you know, there’s one way to ensure that somebody doesn’t get information, it’s to not even include them in the conversation. So the culturally relevant awareness needs to happen and needs to be considered more when creating these materials.
33:46
There’s also a need for culturally specific engagement strategies that really need to be made available and that, you know, this can look like support groups that are not just inclusive have Black people but created by and for the Black community. Just trying to cookie cutter on what works for another group of people is likely not going to work for this community. And there’s you know, ideas about making use of faith leaders and trust, make them trusted messengers and let them link those faith communities and opioid prevention and education and treatment. You know, they already know their communities, they know how to talk to them. They have already been tapped into in the past for other health related conversations. So they’re really well positioned to have that conversation in that dialogue and promote awareness and education in a way that will resonate.
34:47
And people also need to have programs in place that are easily accessible to them. So there have been numerous studies that have found that a lack of transportation is one of the top barriers to treatment for African Americans. So if you can’t even get to your group, there is a higher chance that you are not going to sustain your treatment program.
35:12
And we also need a culturally relevant and diverse workforce in the treatment industry. When Black and African Americans make the difficult decision to enter treatment, and it is difficult for everybody, but but when when you do make that decision, if you don’t see any staff at the treatment facility that you’re going to, and nobody that you see shares a similar cultural background with you. It’s a huge barrier to, to stay in there, to being engaged in that program, to connecting with somebody who understands where you’re coming from, what issues you are dealing with, and just overall building a connection there. And then, of course, as I mentioned previously, Another big area in the workforce that is unequal and hinders the Black populations. accessibility to treatment is in the physicians of color and physicians, including mental health professionals, but especially physicians who are licensed to prescribe medication assisted treatment.
36:25
So where do we go with all of this? Again, I am sharing this as a start as a beginning to exploring what I think more people need to know and understand including myself. And I hope that by speaking up and perfectly taking some imperfect action, rather than doing nothing, that I will find some other people who are willing to engage in this conversation who are willing to see what we can do.
36:59
As a white, privileged female, I can’t just sit and not do anything. And so I will be leaning on the others in this industry, who are more educated than me in this topic to help me to be better and to see what I can do in the areas of awareness and prevention and treatment. Obviously, I don’t own a treatment center or anything like that. But I do feel like my background in marketing advertising could be something that could be put to use. So thank you for letting me stumble through this. Know that I am working to do what I can do and I really encourage you to reach out to me if you are a person who could help help me understand to help others in the industry understand how we can do a better job of actually providing access and treat education and awareness around substance use disorder for the Black community in a way that is helpful and respectful and will actually make a difference.
38:13
Thank you so much for listening, and I look forward to having you back next week. There will also be a special bonus Father’s Day episode coming out on Sunday, on June 21st to celebrate dads out there, it’s an incredibly emotional and fascinating episode that I think you’ll really enjoy. And be sure to pass it along to any man any guy who is struggling with a spouse, a wife or a partner who is dealing with addiction. So that’s a sneak preview for you.
38:49
And as always, I would love your review and your rating. It just helps to bump hope stream up a little bit further in the vast sea of podcasts out there.
39:01
And if you’re a mom who is going through this with your child who is battling substance use disorder, please visit Brendazane.com/thestream. I’ll put that in the show notes as well. That’s our online community built for you created for you to give you support while you need it from other moms who have been in your shoes and who get it, get what it’s like. So I would love to have you join us there. And until then, I will see you back here next week.
