For decades, the opioid crisis has made the headlines of U.S. news. Yet whether it was in its first wave or in its most recent one, there has always been a common factor in the opioid crisis in America: its portrayal as solely a white problem. Regardless of data to the contrary, testimonials, op-eds, and academic research continue to depict the crisis as one-sided, portraying how hardworking white men and women have “fallen” into addiction. The humanity afforded to the opioid-dependent white person stands in stark contrast to the disproportionate incarceration of and lack of treatment available to Black and Latinx people with the same substance use disorder.
Latinx people, in particular, encounter obstacles — implicit biases, language barriers, and immigration statuses, for example — that bar them from seeking and receiving proper treatment to counter their opioid addiction. As a result, between 2014 and 2017, the number of opioid deaths per year nearly doubled for Latinx people. With poverty rates at 19 percent in 2018, over double that of whites, the Latinx community is also more prone to being underinsured or uninsured. Despite all the statistics revealing this population’s vulnerability, the Latinx voice in the opioid crisis has not been heard. If the opioid crisis in America is to be addressed, it must include all communities affected and adjust to these communities’ respective needs.
Rise of the Modern Opioid Crisis
The opioid crisis can be split into three waves, all of which were dominated by inequality and racialized attitudes that have persisted to the present day. A surge in prescription opioids in the early 1990s and overdose deaths in the later 1990s characterized the first wave of the opioid crisis. An increase in the consumption of illicit opiates, such as heroin, marked the second wave of the opioid crisis, beginning in 2010. Finally, the introduction of fentanyl and other synthetic opiates into the market distinguishes the third wave of the crisis, currently ongoing. In late 2017, the U.S. Department of Health and Human Services declared the opioid crisis a public health emergency, shifting away from the tactics of the War on Drugs toward a strategy actually addressing the crisis.
Current government action, however, cannot be discussed without first acknowledging the War on Drugs’ harrowing effects on Black and Latinx communities, which were disproportionately incarcerated by the criminalization of drug use. The characterization of the current opioid crisis as a public health emergency rather than an issue of criminal justice follows closely behind this legacy of discriminatory drug policy. The crack epidemic of the 1980s and 1990s, which predominantly centered around Black communities, was not met with the same sympathy as the opioid crisis is today. Instead, it was met with a War on Drugs — a war that targeted Black people more than it did the drugs.
This racially-charged dichotomy continues today: while people of color are met with declarations of war, white people are met with declarations of public health emergencies. For example, while members of the Latinx community only represent 17 percent of the U.S. population, 50 percent of federal drug cases are brought against people in this demographic group. Furthermore, from the beginnings of the War on Drugs in 1974 to 2001, the chances of a Hispanic male being incarcerated in his lifetime skyrocketed from 4.0 percent to 17.2 percent. In contrast, in 2019 HHS announced $1.8 billion in funding to combat the current opioid epidemic by increasing focus on treatment. As this epidemic largely affected white communities, the objective was to treat, not to incarcerate. This would once again cement the government and healthcare system as unjustly skewed toward the needs of white people.
Despite these clear disparities in the treatment of white communities and communities of color, the government has yet to take definitive steps to address the issue. In an interview with the HPR, Dr. John Newcomer and Carol Caraballo, representatives for Thriving Mind South Florida, cited funding as one of their main struggles as a nonprofit organization serving the underinsured and uninsured population with substance use disorders. By failing to adequately fund programs like Thriving Mind South Florida, the government marginalizes people of color needing treatment for substance use disorders.
The Latinx Experience
Due to the emphasis on the white experience in the opioid crisis, the unique Latinx experience with opioids has been largely overlooked, highlighting greater health disparities among minority groups. To begin with, disparities in pain management are evident in the Latinx community, with Latinx pediatric patients being 30 percent less likely to receive opioid analgesics than white patients. In an interview with the HPR, Joseph Friedman, a graduate student at UCLA’s David Geffen School of Medicine, cited race and income as predictors of whether or not people will receive prescription opioids in their lifetime. This suggests that barriers to treatment ultimately disfavor communities of color in receiving proper pain relief, explaining why doctors are more likely to prescribe opioids to white people for pain management.
Some have claimed that this prescription bias has shielded Latinx communities and communities of color from the opioid crisis. However, in an interview with the HPR, Dr. Jennifer Sharpe Potter, vice dean for research at the Joe R. and Teresa Lozano Long School of Medicine at UT Health San Antonio, warns against using the data in a way that paints these biases as “helpful” or “protective” for the Latinx community: “To argue that [underprescription of analgesics for pain] was protective is to forget all other associated factors … there are inequities for a variety of reasons and disparities in how people of different racial and ethnic groups, underrepresented people, get access to care.” While these biases may have reduced the number of people of color receiving prescription opioids, they have also prevented people of color from receiving proper medication for pain management.
Limited access to buprenorphine, one of the leading medications for opioid addiction, is another deterrent to treatment in Latinx communities. One research team cited doctors as less likely to prescribe buprenorphine to non-white patients. Although buprenorphine is part of medication-assisted treatment for opioid use disorder, many doctors have to go through additional specialized training to prescribe buprenorphine, complicating the process of administering treatment. These specialized physicians are often inaccessible to Latinx patients due to insurance restrictions and other barriers to treatment.
Other solutions to opioid addiction have also faced accessibility challenges. Some hospitals now have bridge programs to help patients throughout the process of recovery. These rehabilitation programs, however, are not always accessible or affordable to the underinsured or uninsured. A 2005 study based on data from the 1999 National Household Survey on Drug Abuse indicated that 87 percent of uninsured young adults with drug or alcohol abuse disorders did not use treatment services. Of those, the uninsured who were of racial or ethnic minorities were even less likely to have used such services. In many ways, the healthcare system is set against low-income and/or undocumented Latinx people with opioid addiction.
Additionally, one of the determining factors in seeking treatment for opioid addiction is immigration status, a prevalent issue for Latinx people. Many federally- and state-funded treatment programs, such as Thriving Mind South Florida, do not receive funding that accounts for undocumented people seeking care. Newcomer, who stated that this lack of funding prevents many people from receiving necessary access to care, cited the exclusion of undocumented people in treatment as a likely result of undercounting in the census, which leads to further cuts in funding. While Thriving Mind South Florida continues to support its community regardless of immigration status and despite a lack of funding, not all organizations are able to do so. Futhermore, undocumented Latinx people with opioid addiction may refrain from using social services for fear of being deported. Funding for organizations and hospitals that serve Latinx communities is essential to addressing the opioid crisis in the undocumented community.
The Latinx community also faces unique problems due to the current cultural and political climate of the United States. In an interview with the HPR, Dr. Todd Schneberk, assistant professor of clinical emergency medicine at USC, said that as anti-immigrant rhetoric has amassed, certain policies are discouraging the use of insurance such as Medicaid, which has “pushed people further into invisibility.” This ultimately compounds the already damaging effects of having little access to healthcare while being undocumented and dealing with opioid addiction.
In addition, patient-doctor conversations regarding pain relief and treatment for opioid addiction are an important factor in Latinx people’s interaction with opioids and may be affected by a variety of cultural barriers. “Professional societies should be providing their members with the tools and techniques that they need to use to have legitimate conversations with patients,” said Dr. Don Goldman, chief scientific officer emeritus and a senior fellow at the Institute for Healthcare Improvement, to the HPR. These conversations may be difficult given an added language barrier, which prevents 20 percent of Latinx people from seeking care in the first place. Goldman speculated that given the nuance and subtlety involved in a doctor-patient conversation regarding opioid addiction, even a small misunderstanding could completely sabotage the goal of treatment. It is clear that Latinx people with opioid addiction already face many obstacles in obtaining proper treatment, which are only exacerbated by cultural barriers that render the healthcare system inaccessible.
Finding Solutions to Move Forward
Given the Latinx experience with healthcare when dealing with opioid addiction, it is essential to find solutions that eliminate the existing barriers. State and federal governments are responsible for providing the funding and large-scale support necessary to end the opioid crisis, but communities also need to take action for the crisis to end. Goldmann contended that “it comes down to local communities enabling services that do not put immigrant populations at risk; state government can make it easier for these groups to operate.” As the opioid crisis has become more deadly, with the third wave introducing synthetics such as fentanyl into the opioid market, it has become more essential than ever that federal and state governments continue to pool resources to train law enforcement and increase access to buprenorphine in communities of color.
Furthermore, it is important to institute proper cultural training to fully eradicate racial bias in the workforce. Goldmann cited “cultural humility” as an important factor for physicians in treating patients from different backgrounds and cultures: “There is a lack of appreciation for what it means to be humble when reaching a shared decision with a patient or a family about pharmacologic treatment for opioid use.” Cultural humility involves more than being “competent” in identifying other cultures; it involves a commitment to fixing “power imbalances” and “developing partnerships with people and groups who advocate for others,” as written by Amanda Waters and Lisa Asbill for the American Psychological Association. Regarding the Latinx community, this means that doctors and medical experts should take a step forward to make sure that this demographic is receiving adequate attention — and not falling victim to cultural, language, or prescription barriers — within the healthcare system.
In addition, harm reduction in communities affected by opioid addiction can help reduce risks associated with drug use. Schneberk said combating such risks, which can include HIV transmission and Hepatitis C infection, is an important component of the harm reduction strategy, which may include needle exchange programs and making naloxone (a narcotic which helps reverse opioid overdoses) available to the public. Friedman offered a similar perspective, but mentions law enforcement as an obstacle in implementing needle exchange programs and other harm reduction strategies: “Giving people clean syringes is only going to work if police are not going to arrest them for it.” If communities are to support those with opioid addiction, it must be on all fronts: through healthcare, law enforcement, and policy.
Given the statistics on imprisonment, it is imperative that law enforcement is trained to identify those who need medical intervention as opposed to jail time. Caraballo, care coordinator for Thriving Mind South Florida, works with Florida police departments to institute “Crisis Intervention Team” training, following an original Memphis model wherein police officers are trained to link those with substance use disorders and mental illness to appropriate services. As a result of CIT implementation in Miami-Dade County, there has been a marked decrease in jail bookings of individuals with “acute psychiatric crisis,” in addition to reduction of harm upon people with mental illness by police officers, as stated by the Eleventh Judicial Circuit of Florida. In short, these community-based, state-supported programs ultimately benefit those who are at high-risk for imprisonment as a result of mental illness, such as opioid addiction.
In a country where the opioid crisis plagues people across all races and ethnicities, it is time to stop pretending it is only a white problem. It is imperative that the same media attention, privilege, and treatment are afforded to all who are experiencing substance use disorders, regardless of their race or ethnicity. In order to ensure that this inequity within the healthcare system is eradicated, it is up to communities and all levels of government to organize and unite to support their most vulnerable.
Image Credit: Creative Commons/jugbo
