I took personal offense when I first heard someone call the opioid epidemic a white man’s disease. My father became an addict in his youth and unfortunately suffered an overdose in middle age. He was not a black man or a Hispanic man. He was a white man.

A Closer Look at the Opioid Epidemic

My father came from humble beginnings. He was not rich, he was not privileged, and he did not graduate from high school. He worked like a horse and did everything he could to make ends meet. I loved him.

Addiction is a crippling disease, and no matter how someone starts down that dark and troubled path, it has many stumbling blocks along the way. Not only does the user suffer but those who love and support him suffer too. For someone to dismiss all that my family had gone through, to label his addiction as a white man’s disease, was insulting at best. Only when I looked closer did I start to understand what they meant.

The Stigma of Addiction

Until more recently, people have been afraid to talk about addiction. It was shameful. Not only did it trigger feelings of guilt, it showed a weakness of character. Addiction was something you did to yourself. It was your fault. You deserved what you got. More than that, it was a crime. It is difficult to get help when people look to blame and arrest you.

The War on Drugs started in the 1970s and made its way well into the 2000s. Fast forward to 2016. The Centers for Disease Control and Prevention released a report, noting a surge in opioid-related deaths. In 2017, they officially declared it to be an opioid epidemic.

Now, instead of pushing people with addiction into dark corners, people are asking them to come out into the light. Instead of judging them for their “moral failing”, they are reaching out to help them with their mental health condition. There are more treatment centers opening, better promotion of mental health counseling, and increased funding for addiction programs. More still needs to be done.

Face the Facts

When you look at the statistics, it is overwhelming. From 1999 to 2016, more than 630,000 people died from a drug overdose, 350,000 from opioids. This only worsened over time. The COVID pandemic made it even worse. In 2021, overdose deaths hit a record high, 71,000 of them from opioids.

The rise in opioid-related deaths came in waves and each wave continues to rise. The first wave, starting in the 1990s, correlated with prescription opioids like hydrocodone and oxycodone. In 2010, the second wave was marked by a spike in heroin-related deaths. The third wave, in 2013, was in line with synthetic opioids like fentanyl, much of the drug being illegally manufactured.

Now take a look at the racial and ethnic breakdown. In 2020, there were 68,630 opioid-related deaths in the United States. (For perspective, there were only 41,260 in 2016.)

— 47,304 (69%) in White, non-Hispanic people
— 11,574 (17%) in Black, non-Hispanic people
— 7,966 (12%) in Hispanic people

More white people are dying from opioids than any other ethnic group. The numbers are glaringly disproportionate.

Racial Stereotypes

People who are prescribed opioids, in theory, are at increased risk for becoming addicted to them. That is the case at least if the doctor is not prescribing them in a responsible manner. Giving too may refills, not monitoring the clinical response, not looking for other pain management options, all of these factors can contribute to an opioid abuse problem. While not all physicians are to blame, better practices need to be established to help people in pain.

Research shows that doctors are less likely to prescribe opioids to their black or Hispanic patients. A 2016 study in Proceedings of the National Academy of Sciences showed some white medical students and residents had biases that contributed to the health disparity.

Doctors prescribe narcotics more cautiously to their non-white patients. It would seem that if the patient is black, the doctor is more concerned about the patient becoming addicted, or maybe they’re more concerned about the patient selling their pills, or maybe they are less concerned about pain in that population.

Dr. Andrew Kolodny, co-director of opioid policy research at the Heller School for Social Policy and Management at Brandeis University, NPR Interview (2017)

Non-white people are being undertreated for pain and it is unfair by every standard. Still, in a twisted way, the racial stereotyping had a protective effect on the population when it comes to the opioid epidemic.

The Effects of Public Policy

In the past, the government criminalized drug addiction. Now, finally, they are pulling back from the stigma and trying to get people the help they need to overcome their condition.

Is it because there is a larger number of deaths overall from opioids? Or is it because those deaths are disproportionately white? Is it truly about how many people are dying? Somehow, it seems that the increasing number of white families affected are seen as having more political clout, especially when you see how badly suburbia has been affected. Politicians will do just about anything to win their votes.

It breaks my heart to see the racial divide. People should be offered help when they need it, not based on the color of the skin. Addiction is a human issue, not a white issue and not a black one. Let’s establish policies that help everyone.

Why We Need to Speak Up

It is no wonder many people keep issues about addiction close to the chest. The world is more accepting but not fully so. Even now people close to me have a difficult time talking about it. They want me to keep my mouth shut. It’s family business, they say. It’s personal. We don’t need people looking down on us. Why bring up the past?

Because I am a doctor and I feel the need to reach out to people. If I can help one person deal with addiction in their life, I have done something good, something meaningful.

Because it is time for the stigma to end. If we are too afraid to talk about addiction, how can anyone truly feel free to speak up and get the help they need?

Because my father did not die in vain. He may have made some unfortunate choices in life but his loss can help other people break free of their addictions. Even in death, he can leave the world a better place.

 

Hoffman KM, Trawalter S, Axt JR, Oliver NM. Racial Bias in Pain Assessment and Treatment Recommendations, and False Beliefs About Biological Differences Between Blacks and Whites. PNAS. 2016 Apr 19; 113(16):4296-4301. https://doi.org/10.1073/pnas.1516047113

Opioid Overdose Deaths by Race/Ethnicity. The Henry J. Kaiser Family Foundation. https://www.kff.org/other/state-indicator/opioid-overdose-deaths-by-raceethnicity/

Overdose Death Rates. National Institute on Drug Abuse. https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates

Race and Addiction. American Addiction Centers. https://americanaddictioncenters.org/rehab-guide/addiction-statistics

Shiels MS, Freedman ND, David Thomas, de Gonzalez AB. Trends in U.S. Drug Overdose Deaths in Non-Hispanic Black, Hispanic, and Non-Hispanic White Persons, 2000–2015. Ann Intern Med. 2018;168(6):453-455. https://doi.org/10.7326/M17-1812

Singhal A, Tien YY, Hsa RY. Racial-Ethnic Disparities in Opioid Prescriptions at Emergency Department Visits for Conditions Commonly Associated with Prescription Drug Abuse. PLoS One. 2016 Aug 8;11(8):e0159224. https://doi.org/10.1371/journal.pone.0159224