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Why Is The Opioid Epidemic Overwhelmingly White?


An opioid epidemic is ravaging parts of this country. President Trump has declared it a public health emergency. Last year, overdoses killed some 64,000 people. It's being compared to the AIDS epidemic of the 1980s and '90s. The face of the opioid epidemic has been mostly white, and that's because we have seen a massive increase in drug overdoses among young white adults, often in rural areas. But what's been happening in black and Latino communities? For answers, we called up Dr. Andrew Kolodny. He's co-director of the Opioid Policy Research Collaborative at Brandeis. Dr. Kolodny, thanks for coming on.

ANDREW KOLODNY: Thanks for having me.

KING: So by the numbers, white communities do seem to be suffering the most from this epidemic or impacted the most. How is opioid addiction affecting black and Latino communities?

KOLODNY: So our new opioid addiction epidemic is sparing African-American and Latino communities, and it's striking when you look at the data. Whether you're looking at overdose deaths or emergency room visits for opioid use problems or treatment admissions for opiate addiction, it's very clear that this epidemic is overwhelmingly white. And it begs the question, why? I can share with you a theory, and it is a theory that's based on evidence.

Something that we do know is that 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. But the black patient is less likely to be prescribed narcotics, and therefore less likely to wind up becoming addicted to the medication. So what I believe is happening is that racial stereotyping is having a protective effect on non-white populations.

KING: Are doctors acknowledging that they're less likely to prescribe narcotics, pain medication, to black and Latino patients?

KOLODNY: I don't think they're aware of it. I think this happens on an unconscious level.

KING: This isn't, of course, the first time that the U.S. has faced a drug epidemic. There's crack cocaine in the '80s and '90s. That was often affecting black communities. Is the response to this crisis different?

KOLODNY: Very different.

KING: Why?

KOLODNY: What we saw from policymakers, what we got from policymakers was a message that we could potentially arrest our way out of the problem. What we got was a war on drugs and a crackdown on crime. What we're seeing now is a very different response now that we've got an addiction epidemic that's disproportionately white. What we're hearing from policymakers, even conservative Republican politicians when they talk about the opioid crisis, many begin by saying, we can't arrest our way out of this. We have to see that people who are addicted can access effective treatment. We didn't hear that during the crack cocaine epidemic. It's good that we're hearing it now. It's too bad we didn't hear it then.

KING: President Trump interestingly has declared this crisis a public health emergency but not a national emergency. If it was a national emergency, that would allow federal funding, even access to FEMA funds to go toward treating it. Does this fall short? Do you think of a national emergency? What's the difference?

KOLODNY: Well, you know, I don't know that the problem is so much the type of national emergency or public health emergency that was designated. My concern is that what we haven't received from the Trump administration is a plan for addressing the problem or a request from Congress for funding.

KING: What would a solution, what would a new system look like?

KOLODNY: One of the first things that we have to do is we have to prevent more people from becoming addicted to opioids, and that's not lecturing to kids, don't do drugs. More than anything else, that's about promoting much more cautious prescribing so that we don't directly addict patients and so that people don't indirectly become addicted because we've stocked everybody's home with a highly addictive drug. But we also have to recognize, now that the genie is out of the bottle, millions of Americans are suffering from opioid addiction. We have to see that they can access the most effective treatments very easily.

If you're opioid addicted, when you wake up in the morning you're going to need to use an opioid pretty quickly or you're going to be feeling very sick. We want that individual to be able to access effective outpatient treatment more easily than they can access pain pills, heroin or fentanyl. If that person wakes up and they've got $20 in their pocket and they know where to go get heroin, that is what they're going to do. We want that person to be able to walk into a treatment center, regardless of their ability to pay for their care, and to be started on treatment - outpatient treatment, that same day.

KING: Dr. Andrew Kolodny is co-director of the Opioid Policy Research Collaborative at Brandeis. Dr. Kolodny, thank you so much for joining us.

KOLODNY: Thank you for having me. Transcript provided by NPR, Copyright NPR.