COVID, race, and drug abuse: The link and next steps

The social, financial, and health impacts of COVID-19 have hit US ethnic minority populations especially hard—deepening existing racial and ethnic disparities. Add to that a disproportionate increase in drug overdose mortality rates in these populations since the pandemic began, and it's an even grimmer picture.

According to statistics, the emergence of COVID-19 in the US was followed by a spike in drug overdose deaths, an epidemic in itself which disproportionately hurts Black, Hispanic, and Latino communities. To prevent drug overdose mortality rates from climbing higher, physicians and other healthcare professionals can routinely assess their patients’ risk for substance abuse disorder, and organize recovery goals for those who have it.^[]

COVID, overdose, and race: The statistics

Prior to the COVID-19 pandemic, the drug overdose death epidemic in the US was already hitting Black, Latino, and Hispanic communities particularly hard, especially since 2015. 

By 2020, however, Black Americans ranked highest in drug overdose mortality rates. Their rate, at 16.3% higher than that for White Americans, exceeded the rate for Whites for the first time in over 20 years. According to a JAMA Psychiatry article, the mortality rate for drug overdose among Black individuals was 48.8%.^[]

These data and corresponding timelines suggest that COVID-19 exacerbated the drug overdose death epidemic in racially and ethnically minoritized communities.

Drug potency's role

The intensifying overdose epidemic is also partially due to an increasingly toxic illicit drug supply. Synthetic opioids and benzodiazepines, as well as high-purity methamphetamine, are major contributors to the crisis, as noted in JAMA Psychiatry.

Stable housing, employment status, policing and arrests, and access to telehealth, harm reduction, preventative care, and access to naloxone are also crucial factors.

Incarceration is another risk factor for overdose mortality. Because structural racism informs the demographics of those incarcerated, Black, Alaskan Native, and Hispanic or Latino individuals are more likely to suffer an overdose-related death in prison. This is especially true for newly incarcerated people, who lack an awareness of changing drug potencies. 

Helping the vulnerable

So, what role do doctors play in this dynamic? Here are a few strategies healthcare providers can employ to tackle the drug overdose epidemic among racial and ethnic groups:

1. Routinely assess for substance abuse. As a doctor, you’re in a good position to note when a patient is exhibiting signs of nonmedical prescription drug use, according to an article published by the National Institute of Drug Abuse. Keep an eye on how frequently patients ask for medication refills. If they consistently request unscheduled refills, there may be an underlying problem.^[]

2. Determine recovery goals. If you recognize substance abuse behaviors in patients, you can de-escalate the issue. Ask your patients directly about their drug use, which may help them see they have a problem. You can then refer them to appropriate treatment  and help them set recovery goals.

3. Look out for new research. Overdose education, access to naloxone, and recovery services are all crucial to managing substance abuse, but these strategies aren’t always employed for the patients who most need them. According to an article published by the NIH, tailored interventions for specific communities where rates of drug abuse and overdose are very high need to be based on local and timely data. Research into structural factors inhibiting access to care among these populations would also be relevant.^[]