Media and pop culture often portray prescription opioid addiction in the U.S. as a scourge of white communities. But recent data suggest a changing reality. While white Americans were more likely than Black Americans to die from overdoses in 2019, the rate of opioid overdose deaths rose 38% among Black Americans from 2018 to 2019, according to a recent study of hard-hit communities in four states published in the American Journal of Public Health. There was no change in the number of overdoses among other racial groups in the states assessed.
The demographic gaps are closing when it comes to who is most affected by prescription opioids. Now, a new study published in the American Journal of Preventive Medicine finds that Black and white patients have been prescribed opioids at similar rates since the early 2000s. The researchers analyzed data from more than 250,000 adults without cancer who were prescribed opioids from 1996 to 2017 and found that on average, from 1996 to 2017, 13.3% of Black patients in the study had at least one opioid prescription, compared to 13.8% of white patients.
This raises concerns, the authors say, that Black patients may face a similar risk of opioid misuse as white patients, even though white people tend to benefit most from the attention, anti-addiction resources and medical treatments devoted to the issue. “Even though the [media’s] focus is on whites using prescription opioids and Blacks using illicit opioids” (illegally obtained prescription pills, or prohibited drugs such as heroin), “when you look at prescriptions…Blacks actually are at the same risk as whites,” says Dr. Virginia Chang, associate professor of population health at New York University Grossman School of Medicine, who co-authored the research with Gawon Cho, a doctoral student at NYU’s School of Global Public Health.
When opioid medications such as OxyContin were introduced starting in the 1990s, they were first prescribed in greater numbers to white patients than Blacks and Hispanics, the study authors write. The potential reasons why are many, including racist stereotypes that some health care providers have historically held which discredit Black patients’ self-reports of pain, and a tendency for novel therapeutics to be used less among under-represented racial groups. But opioid prescriptions accelerated across racial groups in the early 2000s, driven by drug manufacturers’ aggressive advertising campaigns, efforts such as the American Pain Society’s promotion of pain as the “fifth vital sign” to make it top of mind for doctors, and the liberalization of laws governing opioid prescription. Opioid prescriptions for Black patients, in particular, rose precipitously, and during the 2000s, Black and white patients were being prescribed opioids at similar rates. In the 2010s, prescribing limits helped opioid use decline across racial and ethnic groups, though the epidemic continues to rage.
The narrowing gap in prescription rates by race may be part of the reason why overdose deaths among Black Americans are now catching up to those of white Americans, says Chang. However, the increase of opioid prescriptions may provide potential benefits for Black patients—not just risks. When prescribed and used correctly, opioids can appropriately treat pain. Though this study did not delve into the reasons behind the opioid prescriptions, their increased availability to Black patients could be a sign that this population is being treated more equitably. “Not every opioid prescription is bad,” says Chang.
Demographic differences have not completely disappeared. The researchers found that among Hispanic patients, only 10.3% were prescribed an opioid. The persistent lagging number of Hispanic patients to receive opioid prescriptions may be protective of opioid abuse, since Hispanics have fewer overdose deaths than Blacks and whites. At the same time, it may also suggest that this patient population may be receiving inadequate help for pain, says Chang. “For Hispanics, since they are getting fewer prescriptions and they have fewer overdoses, some portion of it could represent under-treatment.” The study notes that although Hispanic, Black and white populations have similar rates of chronic pain, Hispanic patients are less likely to receive opioids than white or Black patients with similar pain levels.
The research only looked at whether or not a patient had an opioid prescription—not the dosage prescribed, which other research has found to be significantly higher for white patients compared to Black patients. Still, the results suggest that Black communities may need more resources for addiction treatment, especially since they have historically had limited access to medications for opiate use disorder. The growing evidence that Black and white people alike often first encounter opioids through a doctor’s prescription could raise awareness that opioid addiction is, in many ways, a medical problem.