People of color were less likely than their white counterparts to be prescribed opioids in the 1990s after they became widely available for non-cancer-related pain — but although those rates caught up by the mid-2000s, media reports tended to focus on prescription opioid use among white people, a new study says.
“To the extent that we think opioids were overprescribed, the media has put most of its attention on whites,” Virginia Chang, an associate professor of social and behavioral sciences at the NYU School of Global Public Health, told MarketWatch.
But the study, published in the American Journal of Preventive Medicine, shows that Black people were eventually using prescription opioids to a similar degree as white people.
“While the media tends to focus the use of prescription opioids on whites and illicit use on Blacks, our findings show that Blacks were as likely to receive prescription opioids, and [were] also at risk for opioid misuse,” said Chang, a coauthor of the paper with NYU School of Global Public Health Ph.D. student Gawon Cho.
Prescription opioid use among Hispanic adults, meanwhile, stayed lower than other racial and ethnic groups during the 2000s and 2010s, the study found — which may have prevented Hispanic adults from having higher rates of opioid misuse, but could also mean they were undertreated for pain.
The research brief analyzed data from the federal government’s Medical Expenditure Panel Survey between 1996 and 2017. It looked at painkiller use among nearly 250,600 adults without cancer.
The study noted previous research attributing the rise of prescription opioid use to increases in chronic pain, national campaigns to improve pain management, liberalization of prescribing laws, and “aggressive marketing” by pharmaceutical companies.
The ensuing surge in overdoses resulted in restrictions on prescribing opioids in the 2010s, leading to a decline in prescription opioid use. The NYU study showed that prescription opioid use “showed comparable declines” across race and ethnicity after these prescribing limits were adopted.
Generally speaking, the findings highlight “the need for racial equity in public health responses to the opioid epidemic,” the authors wrote. They cited research that Black Americans experience more stigmatization and arrests around opioid use and have less access to treatment for opioid-use disorders.
“‘While the media tends to focus the use of prescription opioids on whites and illicit use on Blacks, our findings show that Blacks were as likely to receive prescription opioids and also at risk for opioid misuse.’”
— Virginia Chang, an associate professor of social and behavioral sciences at the NYU School of Global Public Health
The NYU study did not address why people were prescribed opioids or whether opioids were being over- or under-utilized. But new prescription opioids were marketed more heavily in rural white communities in the ’90s, owing to inaccurate racial stereotypes about addiction and pain thresholds, as this New York Times analysis found. And separate studies have found that people of color are less likely to be prescribed medication to relieve pain.
For example, one cross-sectional study published this year in the journal JAMA Health Forum found that between 2007 and 2014, primary-care doctors more often prescribed opioids for back pain to white patients than to patients who were Black, Asian or Pacific Islander, or Hispanic — suggesting, the authors write, that physicians may have been treating pain unequally during a period when the risks associated with opioid use weren’t as well known.
Researchers have also documented the uneven media portrayal of opioid use along racial and ethnic lines: One analysis of 100 popular U.S. news stories from 2001 to 2011, half of which concerned prescription opioid use and half of which concerned heroin use, “revealed a consistent contrast between criminalized urban black and Latino heroin injectors with sympathetic portrayals of suburban white prescription opioid users.”
“Media coverage of the suburban and rural opioid ‘epidemic’ of the 2000s helped draw a symbolic, and then legal, distinction between (urban) heroin addiction and (suburban and rural) prescription opioid addiction that is reminiscent of the legal distinction between crack cocaine and powder cocaine of the 1980s and ’90s,” wrote the authors of the 2016 paper.
Drug-overdose deaths have accelerated during the pandemic. Some 100,306 people in the U.S. died from drug overdose during the 12-month period ending in April 2021, according to provisional U.S. Centers for Disease Control and Prevention data released last month — the first time there were more than 100,000 deaths in a 12-month period. Experts say opioid-related deaths driven by fentanyl, an extremely potent synthetic opioid, are fueling the record number of fatalities.
“We are strengthening prevention, promoting harm reduction, expanding treatment, and supporting people in recovery, as well as reducing the supply of harmful substances in our communities,” President Joe Biden said in a statement marking the milestone. “To all those families who have mourned a loved one and to all those people who are facing addiction or are in recovery: you are in our hearts, and you are not alone.”
Though white people still make up the largest percentage of drug-overdose deaths in the U.S., Black and Hispanic people have represented a rising share of those deaths in recent years, according to an August report by the healthcare think tank KFF. Death rates for drug overdoses increased for all racial and ethnic groups from 2018 to 2020, but Black and American Indian and Alaska Native people experienced the largest increases.
In April, National Institute on Drug Abuse director Nora Volkow laid out “a perfect storm” contributing to overdose deaths involving not just opioids but also stimulant drugs.
“We have people stressed to their limits by decreases in the economy, the loss of jobs, the death of loved ones,” Volkow said. “On the other hand, we see dealers taking the opportunity to bring in drugs such as synthetic opioids and synthetic stimulants and distribute them to a much wider extent than previously seen.”