Discrepancies Amongst Minority Opioid User Populations in North Carolina
Presentation Slide Sources:
- North Carolina Division of Public Health. (2021, May 11). State Unintentional Drug Overdose Reporting System (SUDORS) Fact Sheet. https://www.injuryfreenc.ncdhhs.gov/DataSurveillance/2018-SUDORS-FactsheetFINAL-051021.pdfGoogle
- Images,https://www.banyantreatmentcenter.com/wp-content/uploads/2021/09/opioids-strongest-weakest.jpg, Creative Commons license.
- North Carolina Department of Health and Human Services. (2021, April 16). N.C Overdose Data:Trends and Surveillance. https://www.injuryfreenc.ncdhhs.gov/DataSurveillance/StatewideOverdoseSurveillanceReports/CORE-slideset-November-2020.pptx.
- National Institute on Drug Abuse. (2020, April 3). North Carolina: Opioid-Involved Deaths and Related Harms. https://www.drugabuse.gov/drug-topics/opioids/opioid-summaries-by-state/north-carolina-opioid-involved-deaths-related-harms
Explication:
Discrepancies Amongst Minority Opioid User Populations in North Carolina
In the 1990’s, a rise in prescription opioids for both acute and chronic pain management began after the Food and Drug Administration’s approval of opioid medication. The opioid epidemic has been a nationally recognized health crisis for decades and has been an ongoing issue for the state of North Carolina. However, the racial discrepancies amongst opioid users in North Carolina has gone unrecognized by many with Non-Hispanic American Indians having the highest rate of overdose deaths in North Carolina (North Carolina Department of Health and Human Services, 2018). These non-white minority populations have been subjected to malpractice, mistreatment, and misrepresentation in North Carolina. Though the opioid epidemic is largely recognized as a national health issue, there has been little recognition for minority opioid abusers within North Carolina through limited access to treatment, healthcare practitioner bias, and government regulation of medications and private healthcare.
Racial discrepancies amongst opioid users is a national crisis where in 2015 to 2017, “the African American population experienced the largest absolute and percentage increases in rates of drug overdose deaths involving any opioid or synthetic opioids, with rates for deaths involving any opioid increasing 103%, and for deaths involving synthetic opioids increasing 361%” (Lippold et al. 2019, p. 967). Remarkably, North Carolina has had a pattern of prescribing high rates of opioid prescriptions compared to other states across America. According to the National Institute on drug abuse, “in 2018, North Carolina providers wrote 61.5 opioid prescriptions for every 100 persons compared to the average U.S. rate of 51.4 prescriptions.” This shows that the opioid crisis in North Carolina is extensive, but the lack of knowledge and advocacy for minority groups affected by this epidemic has been shown through many factors, one of which including the disparities of treatments for opioid abuse. In 2019, North Carolina received fifty-four million dollars in federal funding to aid in the opioid crisis where more than twelve thousand north carolinians with substance abuse disorders entered addiction treatment. Out of the twelve thousand participants in the treatment, 88 percent were white, 7.5 percent were African American, and less than one percent were American Indian (Knopf, 2019). The previous year, American Indians had the highest rate of opioid related deaths in North Carolina, yet federal funding for opioid users in North Carolina treated the white majority. Moreover, minorities have limited access to healthcare providers who can prescribe pharmaceutical treatments, are more likely to be administered methadone as a treatment, and are more likely to be referred to a primary care doctor rather than an addiction specialist. Methadone has been highly regulated by the government and has also been found to be ineffective compared to Buprenorphine, an opioid used to treat opioid use disorder. Buprenorphine has been more accessible to white populations due to private practice physicians being the majority of the healthcare practitioners certified to prescribe Buprenorphine (Santoro and Santoro, 2018). Correct treatment needs to become more accessible and affordable to minority communities in North Carolina in order to curb the fatality rate and bring forth egalitarianism.
In healthcare today, racial biases amongst healthcare practitioners remain persistent. Dismissed symptoms and the belief that those with darker skin are biologically different than white patients are just two examples of biases and have led to inadequate treatment towards pain for minorities. In a study conducted by the University of Virginia, the researchers “found that half of a sample of white medical students and residents endorsed beliefs that African Americans have a higher tolerance for pain” (Hoffman et al, 2016). Another study found that stereotype mechanisms are more prevalent during stressful environments or when there is a “cognitive overload”. For example when there are demanding work environments where there is less time to make informed decisions, stereotyping and biases can be made. This is prevalent in emergency situations where acute or chronic pain is assessed (Santoro and Santoro, 2018). North Carolina is the twentieth most diverse state in the country, there needs to be recognition of the racial inequities in quality of care and pain management treatment in order for correct medication prescription and patient care equality to come into consummation.
The management of opioid use disorders has been found to encompass racial inequities. Data from 288 publicly-funded substance abuse treatment centers found that all varieties of pain relievers were less likely to be prescribed to non-white minorities (Knusdson and Roman et al, 2009). Prescribing differences can also be seen in the distribution of Oxycodone Hydrochloride, also coined as the “hillbilly heroin” due to its significance in prescription in rural areas, as directed when first released by Purdue Pharmaceuticals. This substance is highly addictive and could be correlated to the racial discrepancies following the crack cocaine epidemic in the late 80’s and 90’s. The timing of the release of oxycodone hydrochloride seemed to have an impact on the healthcare community following the racialized deployment on the “war on drugs.”’ The Anti Drug Abuse Act signed by Ronald Ragan included a minimum sentencing law regarding the use and distribution of crack cocaine. This included a “100:1 ratio between crack cocaine versus powder cocaine distribution, where crack cocaine distributors were more harshly penalized” (Pouget et al. 2017). It is notable that whites would more often use powder cocaine, therefore the criminalization of minorities was an iniquitous result. Additionally Media representation of minorities, specifically latinos and African-Americans, were often represented as addicts and criminals compared to the white “victims” (Netherland and Hanson, 2016). These racial injustices more than likely affected the distribution of Oxycodone following the “war on drug” movement as the association of substance abuse and non-white minority groups was still new to healthcare providers. The mis-fair criminalization, media portrayal, and initial prescribing patterns of opioids towards minorities have played an extensive role in opioid-related overdose death rates between whites and non-white minorities as seen in the last decade.
The North Carolina Department of Health and Human Services has made an opioid and substance abuse action plan. This plan highlights many important steps needed to curb this epidemic. One point of the six part plan is to “address the needs of justice-involved populations”. The Department of Health and Human Services recommended this course of action would include increased access to drug user health services for historically marginalized populations, as well as acknowledging the systems that have harmed historically marginalized populations. Because this action plan is recent, it is hard to see direct results so early. This is a step in the right direction, but minority opioid death rates are still rising. With more government funding towards more effective narcotic addiction treatment drugs, less government regulated private healthcare, training with healthcare practitioners on racial biases, and educational programs in minority populated areas, there would be more awareness and results in the inconsistencies within minorities and the opioid epidemic within North Carolina.
Script of UP2:
In the 1990’s, a rise in prescription opioids for both acute and chronic pain management began after the Food and Drug Administration’s approval of opioid medication. Since then, the opioid epidemic has been a nationally recognized health crisis for decades and has been an ongoing issue for the state of North Carolina. However, the racial discrepancies amongst opioid users in North Carolina has gone unrecognized by many. There has been little recognition for minority opioid abusers within North Carolina through limited access to treatment, healthcare practitioner bias, and government regulation of medications and private healthcare.
Racial discrepancies amongst treatment for minority opioid abusers is a current issue for North Carolina. In 2019, North Carolina received fifty-four million dollars in federal funding to aid in the opioid crisis where the majority of opioid users treated were white yet the previous year, American Indians had the highest rate of opioid related deaths in North Carolina. Moreover, minorities have limited access to healthcare providers who can prescribe pharmaceutical treatments, are more likely to be administered methadone, a less effective treatment to opioids, and are more likely to be referred to a primary care doctor rather than an addiction specialist (Santoro and Santoro, 2018).
Additionally, racial biases amongst healthcare practitioners remain persistent. Dismissed symptoms and the belief that those with darker skin are biologically different than white patients are just two examples of biases that have led to inadequate treatment towards pain for minorities. In a study conducted by the University of Virginia the researchers “found that half of a sample of white medical students and residents endorsed beliefs that African Americans have a higher tolerance for pain” (Hoffman et al, 2016). The management of opioid use disorders has been found to encompass racial inequities as well. Data from 288 publicly-funded substance abuse treatment centers found that all varieties of pain relievers were less likely to be be prescribed to non-white minorities (Knusdson and Roman et al, 2009). These patterns of injustice for the care of minority opioid users in North Carolina need to be recognized in order to curb the fatality rate and bring forth egalitarianism.
The North Carolina department of health and human services has made an opioid and substance abuse action plan but because this action plan is recent, it is hard to see direct results so early. This is a step in the right direction, but minority opioid death rates are still rising. With more government funding towards more effective narcotic addiction treatment drugs, less government regulated private healthcare, training with healthcare practitioners on racial biases, and educational programs in minority populated areas, there would be more awareness and results in the inconsistencies within minorities and the opioid epidemic within North Carolina.
Sources:
(2021). IVP Branch: Poisoning Data. NCDHHS Division of Public Health. https://www.injuryfreenc.ncdhhs.gov/DataSurveillance/Poisoning.htm
Burgess, D. J., Van Ryn, M., Crowley-Matoka, M., & Malat, J. (2006). Understanding the provider contribution to race/ethnicity disparities in pain treatment: Insights from dual process models of stereotyping. Pain Medicine, 7(2), 119–134. https://doi.org/10.1111/j.1526-4637.2006.00105.x
Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proceedings of the National Academy of Sciences, 113(16), 4296–4301. https://doi.org/10.1073/pnas.1516047113
Knopf, T. (2019, July 9). N.C. uses new federal money to get people into drug treatment, but most of them are white. North Carolina Health News.
Knudsen, H. K., & Roman, P. M. (2009). Racial and ethnic composition as a correlate of medication availability within addiction treatment organizations. Sociological Focus, 42(2), 133–151. https://doi.org/10.1080/00380237.2009.10571347
Lippold, K. M., Jones, C. M., Olsen, E. O., & Giroir, B. P. (2019, November 1). Racial/ethnic and age group differences in opioid and synthetic opioid–involved overdose deaths among adults aged ≥18 years in metropolitan areas – United States, 2015–2017. Centers for Disease Control and Prevention, 68(43), 967–973. https://www.cdc.gov/mmwr/volumes/68/wr/mm6843a3.htm
National Institute on Drug Abuse. (2020, April 3). North Carolina: Opioid-Involved deaths and related harms. https://www.drugabuse.gov/drug-topics/opioids/opioid-summaries-by-state/north-carolina-opioid-involved-deaths-related-harms
Pouget, E. R., Fong, C., & Rosenblum, A. (2017). Racial/ethnic differences in prevalence trends for heroin use and non-medical use of prescription opioids among entrants to opioid treatment programs, 2005–2016. Substance Use & Misuse, 53(2), 290–300. https://doi.org/10.1080/10826084.2017.1334070
Sortoro, T. N., & Sortoro, J. D. (2018). Racial Bias in the US Opioid Epidemic: A Review of the History of Systematic Bias and Implications for Care. PubMed Central, 10(12). https://doi.org/10.7759/cureus.3733
Featured image source
- Brandis, D. (2018). Loaded syringe [photograph]. Unsplash. https://www.istockphoto.com/photo/loaded-syringe-and-opioids-gm1004637310-271320598