Racial disparities in Allegheny County’s fatal drug overdose rates got worse last year. Though overdose deaths have risen across the board, Black residents are now more than twice as likely as whites to die.
Data suggests the death rate for both races is being driven, at least in part, by cocaine laced with fentanyl, a strong and deadly opioid, though Black residents appear to be suffering more.
Fentanyl started to be widely found in the country’s cocaine in 2018, when this racial disparity first emerged in the county. Before that, the county’s fatal overdose rates of Black and white residents were about the same, if not slightly higher among whites.
“Individuals that may not consider themselves to be opioid users are being exposed to the deadly substance, without knowledge, often without any tolerance for opioids,” Allegheny County Health Department’s Otis Pitts said of the fentanyl-laced cocaine.
While presenting 2021 data at a Wednesday meeting for the Allegheny County Board of Health, Pitts explained that because people don’t know they are taking opioids, they’re less likely to have naloxone. The life-saving medication can revive someone after an opioid overdose and has been a cornerstone in the county’s response to the ongoing overdose crisis.
It’s unclear why fentanyl is now commonly found in cocaine; the former makes people drowsy, while the latter is a stimulant. One theory is accidental contamination occurs somewhere along the illicit supply chain. Another possibility is that it’s purposeful, perhaps being added to make more people addicted, thus creating greater demand.
While fentanyl is the drug that’s most commonly present in medical exams of deceased overdose victims, fewer people are dying after using heroin. However, more deaths are occurring after county residents ingest non-prescription synthetic opioids or fentanyl analogues, which have similar chemical structures but are often more powerful.
White residents are slightly more likely to overdose after using these other types of opioids or after using opioids with methamphetamine, another stimulant.
Another factor that’s perhaps contributing to the county’s overdose disparities is that Black residents are also less likely than whites to receive prescriptions for Suboxone. The medication is considered the gold standard for treatment of people with opioid addictions as it binds to receptors in the brain that create cravings for the drug.
Pitts said there are many reasons why Black patients are less likely than whites to receive this medical care, including few providers in certain locations and the stigma surrounding both substance use and treatment. These issues are compounded by the broad systemic inequities Black Americans already face.
In an effort to make this medication more widely available, Pitts said the county is working with primary care doctors to encourage prescribing to Black patients, as well as expanding the provider network.
