The Opioid Crisis: Overdose Among Non-Hispanic Black Residents of Kentucky

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Earlier this year, the President of our Opioid Treatment Program Division here at Pinnacle Treatment Centers, Holly Boce, published an article called “Opioid Overdose Among Older Black Men.” In that article, Holly talked about two problems related to the opioid crisis in the U.S. that don’t get enough attention. The first problem she addressed was the increase in addiction/overdose among older people in the U.S. The second was the increase in addiction/overdose among older non-Hispanic Black men. Specifically, the increase among non-Hispanic Black men over the age of 55.

Here’s the data she used to illustrate these issues.

Opioid Crisis in the U.S.: Older People, Older Non-Hispanic Black Men

  • 2006- 2014: Emergency room visits for opioid-related issues among people 65 and over increased by 220%
  • 1999-2019: 79,883 people over age 55 died of opioid overdose
  • 1999 to 2019: Opioid overdose deaths among all people over age 55 increased 1,000%
  • 1999-2019: Opioid overdose deaths among non-Hispanic Black men increased 1,600%

That increase for non-Hispanic Black men over 55 was 60 percent greater than the increase for the general population over the same period. Experts cite several factors. First, they point to ageism in addiction screening. Next, they talk about access. That includes access to adequate insurance coverage, access to treatment support, trauma, and factors related to the social determinants of health. Holly discusses all of these issues in her article, which we suggest you read to learn more about opioid overdose among older people in the U.S. in general, and the risks for non-Hispanic Black men over 55 specifically.

More recently, we published an article on the opioid crisis in Kentucky, called “The Opioid Crisis: Spotlight on Kenton County, Kentucky.” Our research for that article uncovered a startling development in the state of Kentucky, where we own and operate over a dozen treatment centers.

It’s similar to the nationwide development Holly describes in her article: a disproportionate increase in drug overdose among non-Hispanic Black people. The data we found, however, is neither exclusive to opioids nor non-Hispanic Black men over 55. It shows disproportionate increases in overall drug overdose among all non-Hispanic Black people in the state of Kentucky.

Let’s take a look at that study now.

The Opioid Crisis in Kentucky: Racial and Ethnic Differences in Fatal Overdose

In February 2022, a group of health scientists based at the University of Kentucky (UK) published the paper “Changing Trends in Drug Overdose Mortality in Kentucky: An Examination of Race and Ethnicity, Age, and Contributing Drugs, 2016-2020.” The research team had previously recognized racial and ethnic disparities in need and access to addiction treatment and related services nationwide. To explore this issue on a local level, the research team narrowed their focus to the state of Kentucky. Their goal was to generate evidence public health officials might use to inform addiction and overdose prevention efforts in Kentucky.

The UK researcher team examined:

  1. Changes in drug overdose mortality for various racial and ethnic groups
  2. The types of drugs involved in overdose deaths, i.e. opioids, fentanyl, stimulants

They examined data from 2016-2020 and found significant differences in rates of overdose mortality for non-Hispanic Black Kentucky residents compared to all other racial groups. To confirm their data, we retrieved information for the years  2014-2020 from the publication Opioid Overdose Deaths by Race/Ethnicity published by the Kaiser Family Foundation (KFF) and the Drug Overdose Data Dashboard maintained by the Centers for Disease Control (CDC).

We found the changes they identified are indeed supported by the KFF and CDC data. We also found that the disparities may be greater than the researchers realized.

We’ll focus on their results in a moment. First, let’s compare several sets of overdose data from 2014-2020, starting with the latest figures on nationwide opioid overdose deaths among Non-Hispanic Black people in the U.S.

Opioid Overdose Death Among Non-Hispanic Black U.S. Residents

  • 2014: 2,298
  • 2015: 2,741
  • 2016: 4,374
  • 2017: 5,313
  • 2018: 6,088
  • 2019: 7,464
  • 2020: 11,574

That’s an overall increase of 400 percent over seven years. The largest yearly increases occurred between 2015 and 2016, with an increase of 21 percent, between 2018 and 2019, with an increase of 24 percent, and between 2019 and 2020, with an increase of 55 percent.

Now let’s compare those national numbers with the data from Kentucky over the same time period.

Opioid Overdose Death Among Non-Hispanic Black Kentucky Residents

  • 2014: 21
  • 2015: 26
  • 2016: 58
  • 2017: 58
  • 2018: 53
  • 2019: 82
  • 2020: 148

That’s an overall increase of 600 percent over seven years – of 50 percent greater than the overall increase nationwide among non-Hispanic Black people. The largest yearly increase – 123 percent – occurred between 2015 and 2016, which is five times greater than the national increase among non-Hispanic Black people for that year. The next largest yearly increase – 54 percent – occurred between 2018 and 2019, which is close to double the nationwide increase among non-Hispanic Black people for that year. The third largest increase – 80 percent – occurred between 2019 and 2020, which is 45 percent greater than the national increase among non-Hispanic Black people for that year.

Finally, let’s look at the overdose numbers for non-Hispanic White residents of Kentucky, in order to compare those numbers with those for non-Hispanic Black residents of Kentucky.

Opioid Overdose Death Among Non-Hispanic White Kentucky Residents

  • 2014: 699
  • 2015: 847
  • 2016: 918
  • 2017: 1087
  • 2018: 913
  • 2019: 936
  • 2020: 1519

That’s an overall increase of 117 percent over seven years, which is 80 percent lower than the increase among non-Hispanic Black Kentucky residents for the same time period. For the years during which non-Hispanic Black people showed significant increases – 2015-2016 and 2018-2019 – the yearly increases among non-Hispanic White Kentucky residents were 8 percent and 2 percent, respectively. The largest increases among non-Hispanic White Kentucky residents were between 2014-2015 and 2019-2020, with increases of 21 percent and 62 percent, respectively.

While the increase of 62 percent among non-Hispanic White Kentucky residents between 2019-2020 is significant, it’s also a significantly lower increase than the 80 percent increase experienced by non-Hispanic Black Kentucky residents in the same year.

As a whole, those datasets confirm what the researchers in the U.K. reported. The rate of fatal drug overdose for non-Hispanic Black Kentucky residents is increasing rapidly. The increases exceed those reported for non-Hispanic Black people nationwide. It also exceeded those for non-Hispanic Black people in Kentucky, non-Hispanic White people in Kentucky. And finally – although we didn’t share the statistics – it exceeded those for non-Hispanic White people nationwide.

Overdose, Kentucky, and Non-Hispanic Black People: Why Is This Happening?

To answer that question, we’ll take a closer look at the data from the U.K. study. In addition to overall overdose data, researchers examined hospital toxicology reports to identify the presence of other drugs in fatal overdose victims.

Here’s what they found.

Overdose In Kentucky 2016-2020

  • Overdose involving opioids:
    • Increased 56% among non-Hispanic White residents
    • Increased 80% among non-Hispanic Black residents
  • Heroin involved opioid overdose decreased by 20% among non-Hispanic Black residents
  • Fentanyl involved overdose fatalities:
    • Increased 30% among non-Hispanic Black residents
    • Increased 76% among all residents
  • Stimulant-involved drug overdose fatalities (methamphetamine):
    • Increased 513% among non-Hispanic Black residents
    • Increased 191% among non-Hispanic White residents
  • Cocaine-involved drug overdose fatalities:
    • Increased among non-Hispanic Black residents
    • Decreased among non-Hispanic White residents

In combination with the data from the previous section of this article, which indicates that opioid overdose among non-Hispanic Black residents of Kentucky increased drastically over the past six years, and rapidly from 2019-2020, this data tells us that an increase in the presence of fentanyl and methamphetamine drove the increase in overdose fatality among non-Hispanic Black residents of Kentucky between 2016 and 2020.

That aligns with this 2021 overdoes report from the Kentucky Office of Drug Control Policy (ODCP), which states:

There has been an increase in illicit fentanyl and its analogs within the drug supply. An opioid was involved in 90% of all overdose deaths in Kentucky. Fentanyl was detected in more than 70% of those cases not only in Kentucky, but nationwide. This problem is exacerbated by the widespread availability of potent inexpensive methamphetamine.”

That’s the current situation in Kentucky, with regards to racial differences in the impact of the opioid epidemic. A separate publication from the same research team at U.K. sums it up. Between 2019 and 2020, overdose risk increased 57% for non-Hispanic Black residents of Kentucky, and increased 45% for non-Hispanic White residents of Kentucky.

Addressing Racial Disparities: The Social Determinants of Health

To understand how to address these disparities, it’s important to understand the phrase the social determinants of health. Here’s how the U.S. Department of Health and Human Services (HHS) defines the social determinants of heath:

“Social determinants of health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”

Dr. Maryanne Mason, researcher and author of the study on racial disparities in overdose rates among older adults we mention in the beginning of this article, points to the SDOH when discussing the differences observed in states like Kentucky. In an interview in the online magazine Science Daily, she indicates that the inequities non-Hispanic Black citizens of the U.S. face correlate with and likely drive drug misuse.

Therefore – in addition to expanding access to treatment and increasing awareness about the dangers of opioid addiction – it follows that addressing the SDOH can help mitigate the harm caused by the opioid epidemic. In practical terms, that means ensuring all citizens of Kentucky have access to:

  • Safe housing, transportation, and neighborhoods
  • Education, job opportunities, and income
  • Clean air and water
  • A community free of racism and discrimination
  • Healthy food
  • Outdoor spaces for physical activity
  • Literacy and language education

We agree. When we create a level playing field for people of all ethnicities by addressing the structural challenges facing groups like the non-Hispanic Black residents of Kentucky we discuss in this article, then good things happen. For instance, we increase the likelihood that overall drug misuse, drug addiction, and overdose fatality will decline.

But we can’t take our eye off the ball. Right now, overdose fatalities in Kentucky are increasing most rapidly in the Black community. That’s where we should increase our efforts to reduce the harm caused by the opioid crisis and mitigate the challenges created by the social determinants of health.

We’re up to the task and embrace this work every day at our treatment locations throughout Kentucky.

The materials provided on the Pinnacle Blog are for information and educational purposes only. No behavioral health or any other professional services are provided through the Blog and the information obtained through the Blog is not a substitute for consultation with a qualified health professional. If you are in need of medical or behavioral health treatment, please contact a qualified health professional directly, and if you are in need of emergency help, please go to your nearest emergency room or dial 911.