t his narrative are opportunities for compassion, understanding, treatment and recovery.
Black/African Americans were 29 percent less likely to be prescribed opioids for pain. 21 Racial and ethnic minorities are more likely to experience miscommunication or misinterpretation about their pain with their medical providers. 22 For example, Black/African Americans have higher self-reported pain scores when compared to Whites, 23 yet some doctors choose to believe that pain levels are lower for Black/African Americans compared to Whites 24 or that Black/African Americans are drug seekers. This lower access to prescription opioids for Black/ African Americans contributes to at least two adverse outcomes: a myth of Black/African Americans being “perversely protected” from the opioid crisis is spread 7,25 and the potential for severe under-treatment or mistreatment of pain for Black/African Americans with severely painful medical conditions such as sickle cell disease, certain cancers, HIV/AIDS and other autoimmune diseases. 22 The data show that Black/ African Americans are not “protected” from this epidemic. And, under-prescribing in some cases may have life-threatening consequences for people affected with pain disorders. CHALLENGES TO PREVENTION, TREATMENT AND RECOVERY The social determinants of health and other community and system level factors cannot be ignored when discussing the contextual factors associated with any major public health issue. Described below are some of the key challenges associated with opioid misuse and OUD within the Black/African American population. Negative representations, stereotyping and stigma. Black/African Americans with SUDs are doubly stigmatized by their minority status and their SUD. Negative images of Black/African Americans with SUD contribute to mistreatment, discrimination and harsh punishment instead of treatment and recovery services. Even today, some Black/African American community leaders indicate that using words such as an “opioid epidemic” or “crisis” may be inflammatory in their communities, putting residents on high alert and triggering fears of incarceration. Mostly absent from
Intergenerational substance use and polysubstance use. For many families in the U.S., substance misuse is passed on from generation to generation and opioids are not the first or only drug being used. In some cases, multi-generational households are misusing opioids and other substances together. In communities with high poverty and economic disinvestment, intergenerational and polysubstance use are not uncommon nor unique to Black/African American communities. For many in these poor and low-income communities, using and/or selling drugs is a means of survival. Opioids are not the only substances of concern and are likely not being misused in isolation. An understanding that intergenerational and polysubstance use are common among some impoverished communities, and that disentangling the behaviors of a person’s social network, including their family, are challenging yet critically necessary. Fear of legal consequences. Only 10 percent of people with a SUD in the general population seek treatment. 2 This is magnified in the Black/African American community where there is significant historical mistrust of the health care, social services, and the justice system. For men, there is the looming fear that seeking treatment will result in severe sentencing and incarceration reminiscent of the harsh policies of the past. 7, 26 Stricter drug policies for possession or sale of heroin in New York known as the Rockefeller Laws were put into place in 1973, and the Anti-Drug Abuse Act of 1986 enforced across the country resulted in mandatory and severe sentencing for low-level, non- violent drug offenses, particularly related to cocaine, for a disproportionately high number of people of color compared to Whites. 7 These severe penalties have had lasting impacts on the current criminal justice system, where Black/African Americans represent a substantial percentage of drug offenders in federal prison 9 despite Whites representing the majority of illicit drug users in the U.S. 2 Black/African American women fear losing their children to the foster care system if they acknowledge a substance use problem and seek treatment. 27 These fears are a major
THE OPIOID CRISIS AND THE BLACK/AFRICAN AMERICAN POPULATION: AN URGENT ISSUE
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