The opioid epidemic is still decimating communities. While white Americans in areas with lower levels of economic opportunity bore its brunt in the recent past, the epidemic’s impact across racial groups has changed again. Our history suggests a danger that this could negatively affect our perspective and response.
Until recently, the story of the opioid epidemic has largely been about white Americans in areas with declining economic opportunity. The opioid overdose death rate for white people was at least twice as high than that of other racial and ethnic groups in the US through 2015.
The story — connecting the high rates of overdose to lower levels of economic opportunity — became widely popularized through the work of Anne Case and Angus Deaton as “deaths of despair.” They sounded the alarm for the white working class specifically.
Case and Deaton’s initial work focuses on the decrease in life expectancy and worsening health outcomes for middle-aged white people between 1999 and 2013. But, as Keturah James and Ayana Jordan point out in their work on the opioid epidemic in Black communities, opioid deaths among Black Americans nearly doubled during practically the same period (1999-2015). As they explain, “these deaths have been largely overlooked by the media, and non-white victims of the opioid epidemic are conspicuously absent from political discourse. To attribute this lack of discussion entirely to the low relative frequency of non-white deaths offers an incomplete explanation at best and a wholly inaccurate one at worst.”
Furthermore, while white people have historically faced some of the highest rates of drug overdose deaths, in 2020 the trend changed. Drug overdose death rates across all demographic groups had been climbing, and then exploded during the pandemic. But between 2019-2020, the death rate increased by nearly 45 percent among Black people, compared to an increase of 22 percent among white people and 21 percent among Hispanic people. In 2020, Black people experienced the highest opioid overdose death rate of any group (26.3 deaths per 100,000 people).
Race and racism drive policy decisions and inform how we respond to public health crises. Because the focus of the (recent) opioid epidemic has been about white Americans, its response has differed from the responses to other substance use epidemics. Research has revealed how policymakers responded differently to the opioid epidemic and the crack-cocaine era, by introducing more public health, treatment-oriented policies during the former and more punitive criminal justice policies during the latter. This is reflective of the larger differences in the framing of the two epidemics. The opioid epidemic has been viewed as a structural problem, driven by economic and social factors, whereas individuals who struggled during the crack-cocaine epidemic were criminalized; drug use was viewed as an individual’s problem.
The difference in the responses during different eras of the opioid epidemic says enough on its own. In addition to the ravaging effects of the opioid epidemic today, Black Americans were also devastated by an opioid epidemic, driven by heroin use, in the 1960s and 1970s. But, instead of being met with a public health-oriented response, victims were responded to with the Rockefeller Drug Laws, which criminalized drug possession, first in New York State, and later in other states that implemented similar legislation.
Given the changing racial trends of the opioid epidemic, there’s a danger that our political response and cultural views of the crisis could shift again. Racism has been driving the response to the epidemic the whole time; choosing to focus on how to address deaths primarily among white people is a racialized policy decision, too. But now, because the crisis is disproportionately harming Black people, concerns about federal policymakers scaling back policies that were helping all people are well-founded. Given our history, there is a reasonable fear that they could divert resources from programs designed to address the root causes of the epidemic to initiatives designed to criminalize and punish victims.
We’ve made meaningful progress in how we view substance use disorders; many substance use-related policies being implemented today haven’t always been on the table. A part of this may have been driven by the fact that the opioid epidemic has been viewed as a white problem. Because of this, some may be inclined to suggest continuing to frame the epidemic as a problem affecting working-class white Americans, in order to improve outcomes for all people. But prioritizing problems and crises that affect white populations, ostensibly to help all racial and ethnic groups, isn’t a new strategy, and historically, hasn’t worked in the ways we want it to. There’s a real danger with this approach; it contributes to the erasure of the experiences of Black people. In fact, had we addressed the opioid epidemic head-on, when Black people were the face of the problem, it could’ve helped us mount a more effective response today.
Research for this piece was supported by Arnold Ventures.