Drug Deaths in Black Communities and Our Collective Denial

“Google ‘Children of the Opioid Epidemic,’” said professor Ekow N. Yankah. The search sent me to a year-old New York Times feature about children born to mothers struggling with opioid use disorder.

“How tender a picture is that?” he asked.

The image, a white infant coddled by her mother, was hard to ignore. They stood crouched down on the floor of what could be my childhood home. Mom’s dirty-blonde hair was strewn about, covering her face as she embraced her child. She was asking for forgiveness or redemption or both. I’ve been there.

“That is a picture of a young woman who, whatever her drug addiction is, is fighting to be a decent mother,” Yankah continued. 

Yankah, who teaches criminal law at Cardozo Law School and is a board member of the Innocence Project, made his point. “Compare that with what you know of welfare queens and crack mothers,” he said. “Was there any image like this in the collective mind of our society when we talked about crack mothers?”

It’s a rhetorical question. Images and headlines from the crack-cocaine era remain burned into our psyche. But awareness is not acceptance. So, let’s be honest. It’s no accident that America’s newfound compassion comes during the opioid crisis. Eighty percent of overdose victims are white. 

“We don’t get to move on by pretending that this is a coincidence,” Yankah said. 

“People are saying: look, it’s not racism. It’s that we tried the other model and it just didn’t work,” he continued. “As if for 25 years, we tried to lock up a whole community, and when the color of the community switched, we suddenly grew enlightened.”

There’s Always Been a Cocaine Epidemic

According to the Centers for Disease Control and Prevention, cocaine-related overdose deaths rose about 216 percent between 2012 and 2017. That’s double the growth rate of opioid deaths for the same period.

Most of those deaths happened in black communities. Black adults were twice as likely as whites to die from cocaine-related causes. In 2017 the numbers were 8.3 per 100,000 compared to 4.6. And even though overall deaths rose recently, the data shows that black people have always had double the rate of cocaine overdose as their white counterparts. 

Further data shows that black folks are more likely to develop cocaine dependence or a past-year use disorder. For almost two decades now, we’ve had data that shows cocaine use disproportionately affects black communities.

But today’s headlines make it appear as if it’s a recent phenomenon. “The Opioid Crisis Is Becoming A Meth And Cocaine Crisis,” wrote Buzzfeed last January. “As the Opioid Crisis Peaks, Meth and Cocaine Deaths Explode,” the Pew Trusts noted in May. The list goes on ad infinitum

The cocaine epidemic in black communities is not new. 

Around three-fourths of these fatalities involved fentanyl or other opioids, but we don’t know if the presence of the opioid was disclosed to the user. Officials speculate it could be a contaminated drug supply. More people could also be doing speedballs (a combination of cocaine and opioids).

Whatever is behind the disproportionate rate of overdose, experts remain stumped — and until recently, no one really cared.

Because despite the data, and the appreciation for treatment-based solutions, research remains lacking. A PubMed search shows little to no relevant information. Most news outlets have ignored the issue. 

It’s Just a Cruel Delusion

“Americans really have the sense that history starts anew with every generation,” Yankah said. 

“I schematically undermined your family, and then my children look up and say to your children, ‘look, I don’t know why I’m so much better off. I must have worked harder,’” he continued. 

“It’s just a cruel delusion.”

At first, systemic racism spared black people from the opioid crisis. Doctors are more likely to label black patients as either addicts or drug dealers, so they are less likely to prescribe opioid painkillers. 

But opioid use is rising in black communities. Minority-majority cities like Baltimore, Chicago, and Washington D.C. know this better than most. The opioid crisis isn’t white. Over 47,000 people died of an opioid overdose last year. More than 5,000 of those deaths, or 12 percent, occurred in black communities. 

Black people have less access to life-saving medications like buprenorphine than white people. And due to limited resources, they’re less likely to complete addiction treatment. Even if they do find treatment, almost 90 percent of psychologists are white. As one Philadelphia reporter wrote, it’s difficult to connect in a clinical setting.

Outside Philadelphia’s federal courthouse this summer, activists gathered in support of SafeHouse. It’s the city’s — and the nation’s — possible first planned safe injection site. Family members lined the building with photos of overdose victims. 

Every single photo was white.

“Doing the right thing for the wrong reasons is yet polarizing, divisive, and racist,” Bishop Talbert W. Swan, II told me. Swan, the pastor of Spring of Hope Church of God in Christ, is a civil rights activist and president of the Greater Springfield NAACP

“The wrong reason, of course, is because the addicts are now considered ‘victims’ because they’re predominantly white,” he continued. “The softer, gentler approach is not because lessons were learned by how America dealt with the crack epidemic, but because of white supremacy and the consistent dehumanization of Black and brown people.”

Just Say No

During the crack-cocaine era, murder rates doubled for young black males of all ages. Fetal death rates increased, fathers went to prison, and children, to foster care. Many black urban neighborhoods, which have the highest concentrations of poverty in the country, still bear the scars of those years.

“America needs to remember that the U.S. government allowed the influx of drugs into inner-city Black America and profited from the death, addiction, incarceration, and destruction of Black families and communities,” said Bishop Swan.

He continued: “While Nancy Reagan went around the country telling Black people to ‘just say no,’ her husband Ronald Reagan and Oliver North were funneling proceeds from the sale of crack to the Contras in Nicaragua and funding terrorism.” 

We held black people to a higher standard. Americans preached personal responsibility. But the opioid crisis created victims. We blame Johnson & Johnson, Purdue, Richard Sackler, and our doctors.

“The government will now ensure that pharmaceutical companies pay [restitution] for the addiction of whites to opioids, but will never pay for being complicit in the devastation to Black families and communities,” said Swan.

“While white addicts receive treatment on demand, drug counseling, and a lenient criminal justice system, there are Black people still behind bars because of mandatory minimums, three-strikes laws, and disparate drug sentencing,” said Swan.

We have “collective self-denial” about this disparity, Professor Yankah once wrote. It’s left black people world-weary and bitter. Yankah and Swan agree that contemporary models of addiction treatment are the way forward. Each expressed the need to reflect on our past — not to be cliché — for fear of repeating it.

“One of the things I got a chance to do once was have a thoughtful conversation with one of the first minority judges who is on the federal bench in Miami,” said Yankah. “He spoke about when heroin was ravaging Miami in the 70s.”

“People wanted to wrestle with this problem that was hurting their communities until a bunch of politicians started making hay that the heroin problem was a problem with Hispanics,” he continued. “Suddenly all this money for rehabilitation disappeared.”

Meanwhile, cocaine continues to ravage black communities. Since 2012, cocaine has killed as many, if not more, black Americans as opioids. They die unseen as politicians and policymakers do nothing. There is no New York Times spread, no pharmaceutical company settlement. No one asks about the black children of the cocaine epidemic.

Originally published in The Fix October 11, 2019