Used syringes, used for injecting drugs, on April 21, 2022 in Washington (AFP/Agnes BUN)
In 2020, the overdose death rate among black people exceeded that of white people in the United States for the first time since 1999, according to a study published this year. Its author, Joseph Friedman, a researcher at UCLA University in California, details* for AFP the reasons for this recent shift.
Question: What have been the different waves of opioid overdoses in the United States?
Answer: The first wave came from overdoses linked to over-prescription of opiates, provided to the population via the healthcare system.
Then, when the United States started to drastically regulate their access, a lot of people started using heroin. This caused a sharp increase in overdose deaths as people switched to a more dangerous form of opiate.
Then the third wave is the switch to illegal fentanyl. Illegal fentanyls can be up to 100 times stronger than heroin.
The fourth wave is what we are seeing very recently, with a large increase in polysubstances. People use fentanyl, but also other types of substances at the same time — sometimes intentionally but many unknowingly.
Q: Why did you start studying racial inequalities in overdose?
Chart illustrating how fentanyl and other synthetics have become the deadliest opiates in the United States, and how overdose rates vary by minority (AFP/)
A: There’s been this very powerful discourse in the United States for the last ten to fifteen years that addiction and overdoses are a “white people’s problem.” It is true that during the first wave linked to prescribed opiates, the overdose death rate among white people was higher than among black people. In 2010, it was double.
The reasons are complex but it’s pretty clear it has to do with the structural racism of the healthcare system, which largely prevents access to controlled substances for people of color.
But after this first wave, we saw the death rate among black individuals increase faster than among whites.
Q: What is the situation today?
A: Black populations are disproportionately affected by the switch to fentanyl. For the first time since the 1990s, the overdose death rate for black people exceeded that for white people in 2020. Overdose prevention goals now clearly align with those of racial justice movements.
For the first time since the 1990s, the overdose death rate among black people exceeded that of white people in 2020 (AFP/Agnes BUN)
There is evidence that with fentanyl, incarceration is a very big risk factor for death from overdose. Right after people are released there is a huge spike. Combined with the mass incarceration of black populations, which is a big problem in the United States, this is a key factor.
With drugs that have become so dangerous, it takes a lot of resources to stay safe. Access to care, to treatment, to harm reduction techniques, to housing, to employment…all of these things provide stability. I believe that the inequalities observed for these basic conditions affect the inequalities in the face of overdoses.
All populations use drugs, it is a fact. Who dies from it is dictated by access to resources.
Q: What should the answer be?
A: The war on drugs, the police approach, has been a complete failure. Our overdose death rate is about three times higher than the second worst affected country. And it is twenty times higher than the average. We have the worst overdose death rate in history. Nothing has ever looked like what we are experiencing now.
We really need a major overhaul of how society spends money on drug management. Risk reduction (for example the distribution of clean syringes, editor’s note), is an important solution but does not attack the problems at the root: access to treatment and the dangerousness of the drugs in circulation. In Europe, many places offer heroin prescription programs. It’s the kind of stability that helps people overcome their addiction.
*The interview has been lightly edited for readability.
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