Effects of the “Whitewashed” Opioid Epidemic on Africana People: Chicago, a Case Study

Written by Sureshi Jayawardene

The misuse and addiction to opioids in the US has gained extraordinary attention since President Trump took office last year. In October 2017, the president declared opioid abuse a public health emergency, and Black communities nationwide rose with contempt arguing that structural racism was at the heart of the public motivation to address this issue. This outrage contrasted the nation’s response to the “crack epidemic” of the 1980s. This was a time when urban Black communities were stereotyped as portraying the “crack epidemic,” and the public approach to this crisis was different. Back then, when drug abuse was a “Black problem,” Americans showed little compassion to African Americans battling crack addictions. The media shamed Black mothers with addiction. The national response to drug abuse in the 1980s drew attention to the criminally dangerous drug addict. The media sensationalized the harm caused by crack abuse and “brought us endless images of thin, black, ravaged bodies, always with desperate, dried lips. We learned the words crack baby.” The “crack epidemic” was cast as a pathology of Black communities and the American public viewed this as evidence of African Americans’ collective moral failure. The national rhetoric was that Black people would have to “pull themselves out of the crack epidemic” and could only be allayed by “cordoning off the wreckage with militarized policing.” The nation responded with punitive measures codified in the “War on Drugs” and the public was “warned of super predators, young, faceless black men wearing bandanas and sagging jeans.” The resulting harsh sentencing and mandatory minimums continue to disproportionately affect African American and other communities of color with devastating effects on the incarcerated, their families and children.

The invocation of “war” is absent with the current opioid crisis. Instead, the nation is linking arms to save lives and ramp up rehab initiatives. According to Ekow Yankah, a professor at NYUs Cardozo School of Law, the rallying cries this time around have been issued by various social actors including senators, CEOs, Midwestern pharmacies, and tough-on-crime Republicans who are trying to do something for the real people crippled by opioid addiction. The issue itself has been framed as a problem affecting young, suburban, and rural Whites. Contrary to this popular view, the Research and Policy Center at the Chicago Urban League (CUL) argued, in November 2017, that “this is a wholly inaccurate depiction.” According to the CUL, this predominant “Whitewashed” account eschews the profound effects of the opioid epidemic on communities of color. For instance,

• In Illinois, Wisconsin, Missouri, Minnesota, West Virginia, and Washington D.C., the rate of African Americans deaths from opioid overdose outpace the general population
• In Wisconsin and West Virginia, the African American fatal overdose rate was almost double that of Whites

In Illinois alone,

• Between 2013-2016, all opioid deaths more than doubled among African Americans (132% increase), growing at a faster rate than for any other racial group (IL Dept. of Public Health data)
• Deaths from pain pills increased nearly nine-fold for African Americans, while fatalities for Whites tripled
• African Americans make up roughly 15% of Illinois’ population, but account for nearly 25% of opioid overdose deaths

Shifting focus from suburban and rural geographies typically associated with opioid abuse, the CUL claims the city of Chicago is a unique case study because of the increase in opioid fatalities, increase in fentanyl, and the impact on African Americans. Their study highlights the following data:

• Extreme increase (nearly 75%) in fatal opioid overdoses in just a year
• African Americans make up about 32% of the city’s population, but account for 48.4% of all opioid fatalities
• In 2016, the African American death rate from opioids was 39.3%—essentially 56% higher than the White death rate (25.1%)
• The African American death rate in 2016 (39.3%) was four times higher than the national average in 2015 of 10.4% (CDC data from 2015)
• Chicago neighborhoods with the highest overdose death rate from fentanyl include East and West Garfield Park, North Lawndale, Austin, Humboldt Park, Fuller Park, and Englewood—all poverty-stricken racially concentrated areas

While the public health approach to the opioid crisis is a significant step, as the CUL notes, treatment capacity must necessarily meet treatment needs. Thus far, this has not been the case for Chicago or the state of Illinois. The CUL insists, “African American people, families and communities should not be excluded from narratives told about the opioid epidemic. African Americans must be included in the development and implementation of national and local public health initiatives, as well as in treatment response plans.” Especially since the “War on Drugs” model toward drug addiction is alive and well in Chicago, the CUL urges a public health model that, first and foremost, is evidence-based and therefore, scientifically proven to work. To this end, the CUL identifies three types of intervention:

• Primary Prevention: targets drug use before it begins, implemented in a range of settings including schools, in the community, as well on the individual level.  
• Secondary Prevention: treatment for a substance use disorder, including medication-assisted therapy.
• Tertiary Prevention: additional strategies and initiatives aimed at reducing morbidity and mortality among users, including syringe exchanges, naloxone distribution to users and first responders, drug checking kits, and safe consumption facilities.

​Added to the above multi-layered and evidence-based approach to addressing opioid epidemic, is the need to consider cultural variables in prevention strategies and programs. Not only is a certain respect for cultural traditions, values, and beliefs important in prevention programs. They also require protective factors such as religious and church activity, employment, family support systems, education, racial pride, and communal orientations. Steinka-Fry et al. (2017) determined that culturally sensitive treatments were associated with notably larger reductions in post-treatment substance use levels relative to their comparison conditions in their meta-analyses of experimental and quasi-experimental treatment programs. Current strategies devised to respond to the opioid abuse and fatalities in Africana communities throughout the US must necessarily ensure culture is central to these efforts to enhance the effectiveness of evidence-based programs.
 

Works Cited
Steinka-Fry, K., Tanner-Smith, E.E., Dakof, G.A., and Henderson, C. (2017). Culturally Sensitive Substance Use Treatment for Racial/Ethnic Minority Youth: A Meta-Analytic Review. Journal of Substance Abuse Treatment, 75: 22-37.