There were more than 70,000 overdose deaths in the U.S. in 2019.
This number has steadily been rising since the 1990’s, fueled by the opioid crisis of the last two decades.
Opioid-related deaths have increased from 21,088 in 2010 to 49,860 in 2019. Specifically, prescription opioids contributed to 3,442 deaths in 1999 and 17,029 in 2017.
While prescriptions are directly involved in one-third of all overdose deaths, they indirectly contributed to most addiction cases and subsequent deaths.
The risk of addiction and possible overdose have caused many physicians to rethink how they prescribe these powerful drugs.
On July 21, 2021, The New England Journal of Medicine published a study that looked at the prescription habits of 310 health systems from across the U.S. What they found was that 90% of systems studied had disparities in how they prescribed opioids.
White patients were more likely to receive prescriptions for more pills with higher doses than Black patients. While both Black and white patients received the same number of prescriptions, providers gave white patients 36% more pain killers. These significant disparities cannot be ignored.
Granted, this is nothing new. The prescription gap has been well documented for over 20 years.
While discrimination is undeniable, the motivation for the disparity is not clear. Do providers assume that Black patients are more inclined to opioid abuse? Are providers more sympathetic to the pain of white patients and less concerned about the suffering of Black patients?
We saw the same discriminatory pattern during America’s first opioid epidemic in the late 19th century, which was linked to physicians over-prescribing opiates like laudanum for hundreds of illnesses.
Opioids were prescribed for digestive issues or even infections for which the medical establishment had no cures. In many cases, physicians simply handed out laudanum because they did not know what to do.
The crisis was accelerated by the development of new drugs laced with narcotics, more powerful opioids, emotional trauma linked to the Civil War, and the development of the hypodermic morphine injector.
From the 1870s to 1890’s, addiction plagued many white neighborhoods, but the abuse of opioids did not have the same impact upon Black communities, which either did not have access to these pharmaceuticals or faced the same racist assumptions we see today.
It was believed by many providers that opioid addiction was only a white problem, as the Black mind could not handle the complex thinking that whites experience. Therefore, they were not susceptible to depression and anxiety like whites.
Others thought that Blacks had a higher pain threshold. Most likely, physicians did not pay enough attention to the suffering among Blacks to think about alleviating their pain.
Those physicians who were concerned about addiction often did not trust Blacks to responsibly self-medicate.
The inequality of opioid use and subsequent addiction can clearly be seen among former soldiers. Following the Civil War, large numbers of white soldiers developed addictions.
Since Black soldiers made up 10% of the Union Army, one would expect the rate of addiction to be similar but it was not. Nineteenth century archived medical records rarely mention Black patients who suffered addiction and it is unheard of in military records.
In our time, we see the same pattern of over-prescribing that leads to addiction and drug-related deaths.
The percentage of opioid related deaths from 1994-2011 increased 10% a year for whites yet only 6% a year for Blacks. Thus, by 2010, the opioid mortality rate for whites was twice that of Blacks.
Since 2015, numbers have begun to equalize, as the crisis is now being fueled by heroin and other illegal drugs laced with fentanyl. Just like at the turn of the 20th century, there is a clear link between the over-prescribing of pain killers to white patients and the high opioid mortality rate.
The irony here is that health care providers were more concerned about Black patients abusing opioids while failing to see the crisis their bigotry created in white suburban America.
The story of both opioid epidemics in the U.S. illustrates inherent racial biases in our medical establishment, as well as the multidimensional consequences of racism.
While this type of discrimination is not overt or in our face, it is equally damaging, as it prevents minorities from receiving or seeking services. This then sets up a pattern that goes on for generations, keeping people trapped in poverty and oppression.
This is one of many examples of practices based on racist thinking that contributed to the lack of trust in our health care system among minorities.
This type of discrimination also has secondary effects, such as impacts on how the majority group sees itself. In the case of our opioid crisis, the medical establishment has only in the last decade really acknowledged the impact prescription drug abuse has had on white America.
Subconscious racism within the medical professions unwittingly hid the problem from public view, erroneously thinking this could not possibly be a problem for whites.
Thus, the “war on drugs” mostly focused on and negatively impacted minority populations, with low-level marijuana offenses making up a majority of arrests beginning in the 1990s.
Meanwhile, whites were obtaining, becoming addicted to and overdosing on opioids at an alarming rate, but few were arrested because the drugs were obtained via prescription.
Racism and discrimination not only negatively impact minorities but also destroys the majority racial group, both psychologically and physically.
Discrimination is not a win-lose scenario where one racial groups scores victories over another. Discrimination against one group creates toxic thinking in all groups.
By demeaning the value of anyone, we ultimately decrease and harm the very existential idea of humanity. It is a lose-lose scenario in which one group may suffer less harm but ultimately everyone is negatively impacted.
Senior Staff Chaplain and Clinical Ethicist at the Baptist Health Medical Center in Little Rock, Arkansas.
