The potent drug mix that leads to unprecedented numbers of black Americans overdosing

Opioid overdoses have killed so many Americans in recent years that experts say the epidemic is in its fourth wave. But the current wave of the opioid epidemic poses a new and most insidious threat: Opioids, including the extremely potent synthetic opioid fentanyl, are increasingly being mixed with other drugs, whether the user knows it or not. For example, as of 2019, more than 75% of drug overdose deaths involving cocaine now involve an opioid, as do half of all deaths from stimulant drugs such as methamphetamine.
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When combined with other drugs, opioids have been shown to be particularly deadly for black Americans. American Journal of Epidemiology† Overdose deaths involving more than one substance increased dramatically between 2007 and 2019, but increased much faster among black Americans than whites. Among black Americans, the number of deaths from cocaine opioids increased by 575% during this period — an increase from 0.6 to 4.05 deaths per 100,000 people — while among whites, the death rate increased by 184%, from 0.49 to 1. 39 deaths per 100,000 people.

“People are increasingly dying from stimulants, cocaine, meth, and other stimulants, largely, but not completely, caused by fentanyl contamination from stimulants,” said Tarlise Townsend, the study’s joint lead author and a researcher in New York’s Department of Public Health. York. York University School of Medicine. “We’re now at this point where many experts are advocating that people who use drugs assume that fentanyl is in everything they use.”

Even the researchers were surprised by how dramatic the gap was, Townsend says. “What we found in this study was really, really alarming,” she says. “Not only are stimulant and opioid overdose deaths rising very rapidly in this country, but they disproportionately affect people from marginalized racial and ethnic groups, especially black Americans.” The gap seems to be getting wider. During the last year of the study – 2018 to 2019 – the number of opioid and cocaine deaths among black people increased by 29%, while remaining stable in the white population.

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When opioids are combined with meth and other stimulants in addition to cocaine, white people are still more likely to die from an overdose than black Americans. Between 2007 and 2019, these deaths among whites rose by 3,200%, from 0.09 deaths to 2.97 deaths per 100,000 people. However, they accelerated even faster in the black community, from 0.01 to 1.63 per 100,000, a 16,200% increase.

Expanding access to drug treatment programs, especially for communities of color, is key to helping reduce these deaths, Townsend says. However, there is no easy way to prevent overdose deaths. Unlike opioids, there are no FDA-approved drugs to treat stimulant use disorder, and no evidence-based treatment specifically designed for people with multiple substance use disorder exists yet, he says. townsend. “We definitely need to scale up and develop additional treatment modalities,” she says. “We need to scale up funding for and better focus on opioid prevention or opioid overdose prevention aids for people who primarily use stimulants.”

Black Americans also face certain barriers that make it difficult to receive treatment, said Dennis Bailer, director of the overdose prevention program at Project Weber/RENEW, a Providence Rhode Island nonprofit focused on drug addiction recovery. (Bailer was not involved in the investigation.) Limited and poor insurance options, housing insecurity and excessive police control of black communities stand in the way of treatment for those who need it, he says. Many black Americans also struggle to trust institutions such as health care systems, which they believe have betrayed them, Bailer says. “As a person of color, I feel like the answer for black and Hispanic crack cocaine users [has been] to lock them up,” he says. “That’s what we’ve seen in the past, and that’s why so many people are reluctant to participate. It’s all about the white opioid user. And often we feel like we are sitting in the back seat.”

Making sure everyone who uses stimulants has access to tools designed to prevent opioid deaths can help, Bailer says. These include naloxone (also known as Narcan), a drug used to reverse opioid overdoses. Too often, he says, people who use cocaine or meth think they don’t need Narcan because they’re not taking intravenous drugs — but they don’t realize they’re at risk without their knowledge from stimulants laced with deadly opioids like fentanyl. This is especially dangerous, Bailer says, when the person has no tolerance for opioids. “Many of our cocaine users are simply not getting the message that they are at an equally high risk of overdose [as opioid users],” he says. “People are caught off guard.”

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