Dec 22, 2024 Story by: Editor
International Overdose Awareness Day serves as a moment to honor the memory of those lost to drug overdoses, support grieving families, and encourage individuals in recovery. This day also highlights advancements in understanding the overdose crisis and strategies for combating it. This year brings a glimmer of hope: provisional data from the CDC reveals a 7.5% decrease in overall overdose deaths in the 12 months ending March 2024, marking the largest decline in decades. However, the crisis continues to escalate for certain groups.
A recent New York Times report shed light on the devastating rise in overdose deaths among older Black men in Baltimore, a city heavily impacted by this crisis. This trend, however, is not confined to Baltimore but is evident nationwide. Despite similar rates of drug use among Black and white populations, fatal overdoses among Black individuals have surged at a significantly higher rate over the past decade. Studies reveal that older Black men face some of the highest overdose death rates in the nation.
The growing prevalence of fentanyl, often combined with stimulants, is driving overdose deaths across demographics. Men, in general, are more at risk than women, but factors such as age-related health disparities, social isolation, and lifelong experiences of structural racism appear to intensify this crisis among older Black men, underscoring the urgent need for tailored interventions.
Data from a National Institute on Drug Abuse (NIDA) analysis highlights a nearly fivefold increase in overdose deaths among non-Hispanic Black men aged 55 and older between 2015 and 2023. By 2023, this demographic experienced death rates nearly three times the national average for their age group, with fentanyl and cocaine contributing to the steepest increases. Notably, overdose rates for older Black men are significantly higher than those for Black men overall.
Substance use among older adults of all races and ethnicities has also risen over the past two decades, with treatment admissions increasing for individuals aged 50 and above. Chronic illnesses and pain, more prevalent in older adults, heighten the risk of opioid misuse. Chronic pain not only reduces the quality of life but also raises the likelihood of cognitive decline and early death.
Social isolation further compounds the problem. A National Academies report identifies social isolation as a significant factor in poor health outcomes among older individuals, particularly men, who typically have fewer social supports later in life. Loneliness is a known risk factor for substance misuse. Studies show that older adults living alone and feeling lonely report higher rates of nonmedical drug use. Although older Black and Hispanic adults are less likely to experience social isolation than their white counterparts, a study in Illinois revealed a common profile of socially isolated Black men with alcohol in their systems at the time of overdose.
Health disparities and systemic inequities contribute to the rising overdose rates among older Black men. Discrimination and implicit bias in healthcare result in longer emergency treatment wait times and inadequate pain management for Black patients compared to white patients. Additionally, structural inequities such as underfunded urban areas, housing instability, and food insecurity exacerbate chronic health conditions and premature mortality rates among Black communities.
Discrimination also adversely affects mental health. Data from the National Epidemiologic Survey on Alcohol and Related Conditions links discrimination against Black individuals to increased odds of illicit drug use. Black Americans, like other minoritized groups, face challenges in accessing and remaining in addiction treatment programs. Delays in treatment and limited access to medications like buprenorphine, which significantly reduces overdose deaths, further exacerbate these disparities. Even when older Black individuals receive treatment, they are more likely to have their care prematurely terminated compared to their white counterparts.
The disproportionate impact of fentanyl in Black communities, particularly in cities like Baltimore, underscores the longstanding effects of economic disadvantage and systemic adversity. Overdose death rates for older Black men have consistently surpassed those of other racial and ethnic groups, a trend that has persisted for nearly a decade.
In their widely cited 2015 paper, Princeton economists Anne Case and Angus Deaton introduced the concept of “deaths of despair,” linking economic hardships among less-educated white Americans to rising mortality rates from overdoses, suicide, and alcohol-related diseases. However, economic adversity has long plagued minoritized groups, whose addiction-related struggles often went unnoticed or were criminalized. Overdose rates among Black Americans surpassed those of white Americans again in 2020.
The crisis highlighted in Baltimore reflects a national issue with complex, intersecting factors. Research is vital for understanding why the illicit drug supply disproportionately impacts this population. Exploring the interplay of co-occurring health conditions, pain management, and substance use can inform prevention, treatment, and harm-reduction strategies tailored to these communities.
Historically, prevention efforts have focused on younger populations, but the rise in substance use among older adults calls for new interventions. These may include strategies to prevent opioid misuse among older individuals prescribed opioids for chronic pain, as well as public health initiatives addressing social isolation and loneliness.
NIDA’s Racial Equity Initiative prioritizes research into structural barriers affecting underserved communities. In Baltimore, NIDA’s Intramural Research Program (IRP) collaborates with local organizations, such as barbershops, to provide overdose education and distribute naloxone. Innovative approaches like analyzing hair samples collected from barbershops help monitor fentanyl levels in neighborhoods anonymously, guiding targeted interventions.
Ending the overdose epidemic, particularly among vulnerable groups like older Black men, demands collaboration among healthcare providers, policymakers, community organizations, and individuals with lived experience. Researchers play a crucial role in developing and deploying effective interventions to reach those most in need. Source: National Institute on Drug Abuse
