A recent report by the St. Louis County Department of Public Health on opioid-related deaths revealed a troubling trend.
Deaths of Black men from opioid use increased nearly 50 percent in 2019 compared to 2018. It's an alarming figure, especially given that they were the only group to see an increase.
In fact, the overall number of opioid deaths in St. Louis decreased by 13 percent during the same time period, the first time that's happened in seven years.
Health and substance use disorder experts blame the disparity on deeply rooted social ills that ramp up risk factors while choking off access to treatment.
"We have known for quite some time that communities of color have unequal access," says Nichole Dawsey, executive director of the National Council on Alcoholism and Drug Abuse.
Dawsey says solving the problem will require more than providing Narcan, the widely used brand of overdose-reversing naloxone, to Black and Brown communities, although that's part of it. She says the best thing to do is to be intentional.
"We have done a lot of work — the NCADA and the substance use community in general — to close that gap," she says. In order to make progress, the organization has started to listen.
"We've really been trying to lift up the voices of people of color to have them be a part of our efforts in order to be really intentional about listening to their input on where we could be of better service," she says.
NCADA has been providing Narcan to Affinia COVID-19 testing centers around the metropolitan area and has been reaching out to clergy and religious communities, providing them with information and resources available to their community.
Dawsey says that it's clearly not enough, given the most recent data collected by the county. First and foremost, the issue lies in access. Access to the life saving drug Narcan, education about how to use it and access to counselors who look like the community they serve.
"We know that it is a sad reality that for far too long, white people with substance use disorders are most often channeled into treatment and recovery groups. But we know that Black and Brown people, particularly Black men, are hesitant to ask for help with a substance use disorder in fear of being criminalized," Dawsey says.
These numbers bring opportunity to NCADA and other substance use disorder centers to make changes.
"Not only do we as a field need to be more intentional about dismantling the systemic racism that surrounds substance use and drug policy, but we need to keep working in this space," she says.
She says that the numbers point to a need for widespread education of what addiction is, a better understanding of the stigma that surrounds it, and a need for interventions that do not result in simply putting someone behind bars.
Dr. Will Ross, the associate dean for diversity at Washington University School of Medicine and chairman of Joint Boards of Health and Hospitals, is alarmed by these numbers, but not surprised.
Ross says that in the past few years, the medical community has been seeing the rise of opioid deaths of white males in the United States. They use the term "diseases of despair," because the community felt this population was more susceptible to death because of the economic pressures and lack of opportunities.
"There's a lot of sympathy and concern for that particular demographic group," Ross says. "This is a matter of continuum. At some point we were going to see the same phenomenon in African American men because the same level of social factors are contributing to the despair. Actually, they are magnified."
As a Black man, Ross is concerned. "Will we have the same level of support, concern, empathy with the African American male population?"
Ross says that African American men are much more vulnerable to these social and structural barriers that make getting help difficult.
"With the current dynamics of this country, African American males are going to be less supported if they seek a provider," Ross says. Similar to Dawsey, Ross is concerned about access to Black physicians and health care providers that are able to provide culturally appropriate care.
"In African American men, there is a heightened level of a sense of frustration, anxiety, a great amount of pressure due to joblessness, and lack of access to providers. That translates to higher deaths from opioid overdoses," Ross says.
"We know that people use substances to cope with a pain, usually an emotional pain, sometimes it's physical," she says. During this time of isolation, these feelings can be more overwhelming and difficult to deal with, resulting in an increase in drug use.
As part of its work to combat addiction and close the access gap, Dawsey says the NCADA has been working internally on being anti-racist.
"We haven't released a public statement because, for us, the work has to continue to happen internally so we can show up to the community as our best selves, in the ways the community needs us," she says.
On a positive note, Dawsey does think that the overall decrease of overdoses does point to distinctive progress.
"As Narcan has become more widely available, and as more people understand that addiction is a chronic disease rather than a moral failing, more people are able to get the help they need," she says. "Treatment options have expanded and have become more coordinated. Medication-assisted treatment is utilized more broadly, and peers have been trained and mobilized."
Ross thinks the next steps include hiring community health workers to go out and identify those at high risk of addiction and overdose and to provide them with Narcan.
"We need to start greater elements of discussion around the educational use of Narcan and, where possible, direct these at risk individuals to mental health services in the county," Ross says.
If anything, officials say, the numbers are another reminder of the work ahead.
Correction: This article has edited to fix the wording in several misheard quotes. We regret the errors.