Addressing Inequities: The Overdose Crisis Among Black Americans

As part of GHAI’s Overdose Prevention Initiative and its ongoing efforts in reducing inequities in overdose deaths, this is the first of a series of interviews with experts in the field. Phil Rutherford currently works as the strategy lead on substance use at the National Council on Mental Wellbeing. For the past 15 years, he has engaged in the nonprofit space, focused on substance use disorder treatment and recovery. With deep roots in in the realm of health equity, he has facilitated transformative organizational equity projects and awareness campaigns.​ Phil is an important leader in the effort to prevent overdose deaths, and GHAI discussed the importance of the overdose crisis among Black Americans below. 

1. Recovery from substance use disorder looks different for everyone—for many it's not as simple as engaging with treatment then discontinuing drug use, but rather is a broad continuum of support and care. As a person in recovery and a recovery coach, can you walk us through some of the supports needed to sustain recovery?

   Rutherford: I think we need to reframe the discussion, starting with the word “recovery.” I consider myself a member of the recovery community, but what that really means is that I am socially and environmentally connected to a group of people with a common aim. It’s not much different from being connected to a faith tradition, a civic club, or a membership group. 

   As for support needed, I’m reminded that substance use disorder (SUD) is one of the most treatable chronic diseases. Interventions like treatment, medication and psychiatric care can support you. The challenge is that those treatments don’t occur in a vacuum, and like other illnesses, are highly dependent on phenotypic factors.  Having culturally specific support and representation in clinical care can have a great impact. 

   There is a systemic lack of culturally competent treatment and recovery support resources. A large percentage of Black people who meet the clinical criteria for SUD don’t get treatment. According to research at Yale, Black patients are 70% less likely to be prescribed buprenorphine- a gold standard of opioid use disorder (OUD) care. 

    

2. To achieve recovery and reduce the number of overdose deaths among Black Americans, there must be an investment in culturally competent resources for Black communities. Where do you see federal resources lacking and how do you think they could be best allocated to support Black communities?

   Rutherford: There are layers of challenges here. It would be easy to just say we need more funding, but funding is only part of the issue.  To remedy this situation, we need large scale investments in infrastructure, development and maturation of representative caregivers, provision of services, research and a reimagining of the way we provide care. 

   Funding gets lost in administrative burden, and by the time these resources reach the community, they are sparse and laden with pitfalls that many small nonprofits deal with. We need to look at the Centers of Excellence and Technical Assistance models that SAMHSA and CDC have used effectively. These centers can sometimes break through the state level bureaucracy and get resources directly to the organizations that need it. 

    

3. Stigma surrounding substance use and addiction is a significant barrier in accessing treatment and recovery resources. Can you speak to how stigma has historically impeded equitable access to treatment and recovery in Black communities?

   Rutherford: Stigma exists both internally and externally.  One of the legacies of the War on Drugs and the cocaine that flowed into Black communities in the 80’s and 90’s is a perception of Black people who use drugs as violent and dangerous. This isn’t a new trope, as Black men have consistently been vilified. Some people use the term crack or crackhead as some sort of joke, or to describe something as irresistible, but that’s stigmatizing and a misunderstanding of SUD. 

   Research shows distinctions in race regarding OUD.  In one report, Black people were being routinely described as junkies and heroin addicts, while their white counterparts with the same diagnosis were described as people with OUD. Stigma exists in many dimensions. A National Institutes of Health study with adolescents and medical students showed that when presented with the same diagnosis, medical students were 25% more likely to take a punitive view of Black patients.

   Inside Black communities, a history of over policing, mass incarceration, involuntary psychiatric commitments, negative interactions with medical professionals and misinformation have created an environment where stigma is rampant.  This negative response is exacerbated by centuries of genetically transmitted trauma, and unfortunately, this will need to be repaired person by person, brick by brick, and block by block.