:format(webp)/cdn.vox-cdn.com/uploads/chorus_image/image/48634883/GettyImages-481663359.0.jpg)
Amid all the horrors of the opioid painkiller and heroin epidemic, one good bit of news is that it hasn't hit minority communities very hard. But there's never really been, in my view, a satisfactory explanation for this: Why are minority communities avoiding the worst of the epidemic?
Well, the New York Times has a possible explanation — and it's disheartening. Gina Kolata and Sarah Cohen reported for the Times:
There is a reason that blacks appear to have been spared the worst of the narcotic epidemic, said Dr. Andrew Kolodny, a drug abuse expert. Studies have found that doctors are much more reluctant to prescribe painkillers to minority patients, worrying that they might sell them or become addicted.
"The answer is that racial stereotypes are protecting these patients from the addiction epidemic," said Dr. Kolodny, a senior scientist at the Heller School for Social Policy and Management at Brandeis University and chief medical officer for Phoenix House Foundation, a national drug and alcohol treatment company.
It's a troubling possibility: Basically, doctors didn't give black patients drugs that were thought to be needed for pain treatment due to racist stereotypes. Then white patients who got the drugs became addicted, and some, over time, shifted to another, cheaper, more potent opioid — heroin — to satiate their addiction.
To be clear, the doctors' stated fears — that black patients are more likely to illegally sell and get addicted to drugs — are based on false stereotypes: The research shows black people aren't more likely than their white counterparts to use or sell illicit drugs.
The result is an opioid epidemic that has disproportionately hit white Americans. A 2014 study published by JAMA Psychiatry found that nearly 90 percent of treatment-seeking patients who began using heroin in the previous decade were white — a big shift from equal racial representation prior to the 1980s.
The disproportionate impact of the current epidemic on white communities, however, may be one reason the response to the crisis has been fairly different from the response to previous drug epidemics. While the crack cocaine epidemic, for instance, produced a response mostly through the criminal justice system, the opioid epidemic has led mostly to a public health response. Race offers one explanation for that historical discrepancy.
How race and class have affected the opioid epidemic
Last year, Katharine Seelye reported another story for the Times that exposed some of the racial differences in how public officials are approaching the opioid epidemic. Take, for instance, this anecdote from a police officer:
So officers like Eric Adams, a white former undercover narcotics detective in Laconia, are finding new ways to respond. He is deployed full time now by the Police Department to reach out to people who have overdosed and help them get treatment.
"The way I look at addiction now is completely different," Mr. Adams said. "I can't tell you what changed inside of me, but these are people and they have a purpose in life and we can't as law enforcement look at them any other way. They are committing crimes to feed their addiction, plain and simple. They need help."
Adams couldn't explain what changed inside of him. But it's possible that race could have played a factor: Maybe Adams and other police officers are more likely to see a heroin addict as a victim simply because the addict is now more likely to be white and middle-class.
There's some solid evidence behind this idea: The research shows the public and police possess subconscious biases that make them more likely to view black people and other minorities as less innocent and more criminal.
The history of past drug epidemics also tells the story. During the 1970s and '80s, federal and state lawmakers reacted to the heroin and crack cocaine epidemics of those times with punitive tough-on-crime policies, including the launch of the war on drugs. And those older epidemics primarily hurt lower-class, minority groups in urban areas — not the middle-class and wealthier white people in rural and suburban places mostly hurt by the opioid epidemic of today.
Race and class also may play a role even for someone who's free of subconscious or overt racial bias. Since lawmakers tend to be whiter and wealthier, they may not have had personal contact with victims of past drug crises. But they do today — and many of them even share personal stories in their push for drug policy and criminal justice reform. By simply having more personal contact with addicts, lawmakers have been driven to treat the current epidemic as a public health, not criminal justice, issue.
This is essentially what Michael Botticelli, head of the White House Office of National Drug Control Policy, told the Times: "Because the demographic of people affected are more white, more middle class, these are parents who are empowered. They know how to call a legislator, they know how to get angry with their insurance company, they know how to advocate. They have been so instrumental in changing the conversation."
Race and class probably don't explain the entire story
There is one caveat to the race and class explanation: The opioid epidemic coincides with a criminal justice reform effort that largely began before the current drug crisis was well-known in the mainstream. The reform effort by and large started, particularly in conservative states, as an attempt to cut the costs states were facing from locking up so many people. So while race and class have likely played a role in the softer public health approach to drugs, there are other factors, too.
Of course, that caveat doesn't do anything for the millions of minority Americans who were disproportionately arrested and incarcerated for their addiction in previous decades. For them, it increasingly looks like if they had been born at a different time or of a different class and race, their lives wouldn't have been ruined by an approach to justice that the public and political leaders now by and large see as far too harsh.
