Not Just a White Problem

Minorities Are Dying of Opioid Overdoses. Rhode Island is Fighting to Stop It.

By Gaya Gupta and Ivy Scott

Both nationally and state-wide, rates of opioid misuse among people of color are similar to that of the general population, according to a study from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). Yet overdose death rates are increasing among Black and Hispanic Rhode Islanders, but decreasing among whites.

An analysis of data recorded by Rhode Island’s Emergency Department 48-Hour Opioid Overdose Reporting System revealed that the rate of overall opioid misuse in the state is roughly 0.35% among Blacks and 0.45% among whites.

But in 2019, Black residents in Rhode Island experienced an overdose death rate that was nearly double the rate for white residents, according to a recent report analyzing fatal overdoses from the Rhode Island Department of Health (RIDOH).

That same year, Hispanic residents experienced higher rates of overdose death than non-Hispanic residents, according to the same report.

A breakdown of Rhode Island population by race/ethnicity in 2019. Data: Census ACS data. Graphic: Hal Triedman.

This data parallels national trends recorded by the U.S. Center for Disease Control and Prevention (CDC). In small-to-medium sized cities like Providence where the population is less than one million, researchers found that the opioid overdose fatality rate for Black Americans increased 82% between 2015 and 2017, the biggest jump of any racial group. Despite evidence to the contrary, however, the perception prevails that Black Americans and other minority groups are not significantly impacted by the opioid epidemic.

“We need to look at population rates as opposed to crude numbers, because yes, there might be more white people dying, but they also make up a higher percentage of the country,” said Jacqueline Goldman, an opioid overdose researcher at Brown University’s School of Public Health. “When you break it down into rates, you see that in Rhode Island, overdoses are happening in zip codes that have higher proportions of people of color.”

The Rhode Island medical examiner’s office, which tracks accidental overdose deaths across all drug types, said that Providence, East Providence and Woonsocket were the cities and towns hit hardest by Black overdose deaths between 2016 and 2018.

The proportion of overdose deaths split up by race Providence, Woonsocket, East Providence and statewide. Though white people make up most opioid overdose deaths, Hispanic and Black Rhode Islanders overdosed at higher per capita rates. Data: RIDOH. Graphic: Hal Triedman.

Dennis Bailer, one of the few Black employees at the addiction recovery organization Project Weber/RENEW in South Providence, added that many people who consider the epidemic a white problem “just aren’t seeing the whole picture.” Bailer, who has overcome his own battle with substance abuse, explained in an interview that while the abuse of prescription pills is most prevalent in white communities, the usage of heroin and synthetic opioids is steadily increasing in minority groups. Particularly with the introduction of fentanyl into the state’s drug market, synthetic opiates are making their way beyond pills into marijuana, cocaine, and other drugs.

“It's unfortunate that we're not looking at the minorities who are being affected, we’re only looking at the white individuals being affected,” said Bailer of outreach efforts over the past few years. “Fentanyl has gotten into the cocaine supply, into the meth supply, it’s affecting everybody.”

For years, nationwide outreach efforts to combat opioid misuse have continued to primarily target a white middle-class audience. A report published in 2020 by SAMSHA concluded that “there is a lack of public awareness campaigns about opioid misuse and OUD [opioid use disorder] for Black/African American communities.” The SAMHSA findings pointed specifically to an absence of campaigns focused on harm reduction strategies such as syringe services programs and naloxone education and distribution.

Blacks and Latinos often have “limited access to recovery services” including medically-assisted treatment like the use of methadone, suboxone, or buprenorphine to treat opioid use disorder — a trend also reflected in Rhode Island.

Rates of methadone use for white Rhode Islanders in 2020 were nearly double the rates for African Americans, according to data from the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities & Hospitals (BHDDH). This same rate for whites was also 20% higher than the rate of methadone use in the Latino community. Goldman believes that these disparities in both death rate and usage of medically-assisted treatment can be largely attributed to the fact that substance abuse in minority communities is not always treated as a medical issue.

“We need to take away our biases that the overdose crisis is just impacting white people,” Goldman said. “Overdose is unfortunately universal, but… people of color are dying at very high rates because they might not have the access to resources and treatment that white people do.”

On the Prevent Overdose RI website — the state’s information hub for all things opioid-related — the Department of Health openly states that “these are trends happening across the country because of systemic racism.” And while the coronavirus pandemic has only worsened the existing healthcare inequalities that contribute to minority groups’ struggle to access key recovery resources, some outreach workers in Rhode Island are also pointing to a more specific reason why so many minorities are now dying of opioid overdoses.

Dr. James McDonald, RIDOH Medical Director, explained that in addition to the impact of COVID-19 and the growing prevalence of fentanyl in non-opioid drugs, fentanyl’s ever-increasing potency is also partially to blame.

“Over 25% of the fentanyl out there has more than a lethal dose in it,” McDonald said, citing information he has received from police officers across the state. “And if it shows up in communities where there are more people of color, then there's greater risk in that community.”

In order to combat these trends, both state employees and community organizations are actively working to diversify their approach to opioid outreach. BHDDH Director Kathryn Power, who also co-chairs Governor Gina Raimondo’s Overdose Prevention and Intervention Task Force, believes that the state’s efforts to reach out to marginalized groups must begin with a more representative team of outreach workers who understand how best to connect with minority communities.

“One of the biggest priorities is to have people working in the field who reflect the people that need the care,” Power said of the task force. “We have to get a workforce that reflects a majority of the racial and ethnic minority groups in our state.”

Many recovery organizations, including Project Weber/RENEW and Anchor Recovery, have already taken the first step to diversify their staffs.

“It was very lopsided for a while, but we’re trying to make sure that we have more peer recovery specialists who are people of color,” Bailer said. “We have three Spanish-speaking staff members so we’re reaching the Hispanic, Latinx community as well.”

Bailer works alongside Weber/RENEW’s Assistant Director Lily Rivera on the Overdose Prevention and Intervention Task Force. This year, Rivera will join a newly formed subcommittee on the Task Force designed to specifically target Latino communities — who comprise roughly 16% of the state’s population — and improve their access to harm reduction resources and treatment.

“There’s a lot of Latinos that have been swept under the rug,” she said. “Blacks and Latinos are high risk populations, but there was not enough of an invitation for folks of color to be represented on this task force.”

Chief Zachariah Kenyon, who runs the Providence Fire Department’s Safe Stations opioid outreach program in partnership with Anchor Recovery, said that Anchor also has two bilingual peer counselors who work with Spanish-speaking users.

The Safe Stations program is a 24/7 initiative started in Rhode Island by Chief Kenyon to instantly connect anyone struggling with substance abuse who comes into a Providence fire station seeking help with a peer recovery counselor. In addition to his work for Project Weber/RENEW, Bailer also works as one of Anchor’s peer counselors for the Safe Stations program. He emphasized the importance of having counselors from diverse backgrounds who can empathize with users from minority communities.

“We share our own experiences — we've been homeless and we've had these law enforcement encounters and we've gone to treatment and detox centers and know how difficult it can be to navigate those systems,” said Bailer. “People tend to open up and relate better with somebody who actually has lived those experiences, there’s no doubt about it.”

Though not a person of color himself, Chief Kenyon has been one of the leaders pushing hardest for increased outreach in media campaigns for minority communities. Kenyon explained that in previous years, Safe Stations advertisements were primarily directed at young Caucasian males. However, in 2020 the program opted to run a series of advertisements on Spanish radio. Since Hispanics were not considered to be the “target audience” for opioid overdose campaigns, Kenyon said that no one expected much of a response from the community. But shortly after the advertisements aired, Providence fire stations saw a burst of Hispanic residents coming in and asking for help. Outreach workers at places like Anchor and Weber/RENEW now distribute Safe Station flyers in English, Spanish, and Portuguese.

“One of the big issues is just getting the word out that all these [resources] do exist,” said Kenyon, adding that the overdose prevention community can often feel like “an insulated world” far removed from the places where recovery resources are most needed.

In a recent discussion between Project Weber/RENEW and RIDOH officials about the state’s overdose prevention media campaigns, Bailer said that his team pointed out “how some of the ads were definitely marketed toward what seemed to be a suburban white person.” They advised state officials to consider changing some of the images and language used “so that people don't feel like they're left out.”

Already, RIDOH is working with the Overdose Prevention and Intervention Task Force on the 10,000 Chances Project, which will distribute 10,000 naloxone kits around the state in 2021, focusing on minority and low-income communities. RIDOH has also updated the Prevent Overdose RI website to include a full translation of all resources in Spanish and Portuguese, as well as partial translations in four other languages.

Goldman noted that while changes like these are a step in the right direction, it’s not always enough to simply translate outreach efforts word for word. Different communities have “different layers of stigma, cultural beliefs, and slang,” said Goldman, adding that certain communities, especially Spanish-speaking ones, benefit from outreach that uses more nuanced and culturally sensitive language.

Power agrees. She said that both Task Force members and state officials are actively considering how to make their outreach resources more culturally appropriate for minority groups. One recent endeavor was the creation of a 24/7 hotline for medically-assisted treatment, managed by the BHDDH, which provides access to buprenorphine within 24 hours to those who call. The hotline works with bilingual translators to minimize the number of linguistic barriers that Spanish speakers encounter when seeking treatment for their addiction.

For Bailer, all of these initiatives are only the beginning of the battle to reduce the number of minorities dying of opioid overdoses, and make outreach services more inclusive in the long-term.

“Change is difficult and change doesn’t come quickly. But being a man of color who felt like I didn’t fit into a lot of the supports that are out there, I have to remain hopeful,” said Bailer. “I’m hopeful that we can make changes so other people of color who are trying to get help don't come across that same feeling. Like somehow it's not meant for them.”

— Data on fatal and nonfatal overdoses in Rhode Island provided by Hal Triedman. Graphics by Hal Triedman.