Mostly whites receive NC drug treatment

By Taylor Knopf

N.C. News Service

State officials announced last month that over 12,000 people with substance use disorder entered addiction treatment since North Carolina received $54 million in federal grant funding to address the opioid crisis.

Opioid addiction is widespread in North Carolina, and an average of five people die per day from overdose. It affects people across the state from every race and socioeconomic background. However, the majority benefiting from the grant treatment money are white.

The state health department collected demographic data on 10,333 people who entered substance abuse treatment over the past two years through the 21st Century Cures Act State Targeted Response to the Opioid Crisis Grants. Of those served by the grant, 9,085 (88 percent) were white, while 775 (7.5 percent) were black. Fewer than 1 percent of the beneficiaries were American Indians.

Meanwhile, the rate of overdose deaths among American Indians in the state was 1.3 times higher than the overdose rate among the total state population from 2000 to 2016, according to a recent article in the North Carolina Medical Journal. Authors of the article found that rates of hepatitis C infection among the American Indian population are also particularly high. They go on to point out that the state’s opioid action plan fails to mention the American Indian population, while addressing other special population groups, such as pregnant women.

Kaiser Health News reported earlier this year that white drug users had “near-exclusive access to buprenorphine” — also known as Suboxone, an addiction treatment drug — during a period when black people were dying from overdoses at higher rates than white people. Public health experts attribute these disparities to several factors, including bias within the medical system and overcriminalization of minority drug users.

Methadone was first used in clinical trials on inner-city minorities to treat heroin addiction, the authors wrote. Many of the clinics are still located in minority communities, where their locations and the people who use the clinics are visible to the public. Furthermore, patients must visit them daily, adding to the burden of treatment along with creating added stigma. Additionally, methadone clinics are highly regulated by government authorities and largely funded by Medicaid, they explained. “Treatment is complicated for Medicaid patients due to the inconsistent funding or time-restrictions that are imposed by Medicaid,” the researchers wrote. “This is detrimental to the patient as it can impede their success for treatment due to the higher chance of relapse with sub-optimal dosing of methadone.

“Additionally, even when access is available, non-white minorities utilize the services at half the rate of Caucasians due to the financial burden associated with overcoming multiple barriers.”

Meanwhile, buprenorphine is a partial opioid antagonist, which makes it harder to abuse than methadone. It can be prescribed by physicians who undergo training to obtain a special federal waiver and are then willing to do special record-keeping. Until 2017, physicians were limited to only 100 patients who could receive the drug (they can now apply to prescribe up to 275 patients).

 “Since private practice physicians are more likely to be certified to prescribe buprenorphine, there is less likelihood that minorities have access to these treatments.” the authors wrote.

Some harm reduction advocates argue that minority drug users have less access to drug treatment because they are incarcerated at higher rates than white drug users. According to the NAACP, both African Americans and white people use drugs at similar rates. However, African Americans are incarcerated for drug-related charges at six times the rate of white people. Other sources suggest the rate discrepancy is even greater.

“As an African American, if I’m a drug user, what it means for me to be an injection drug user in America is not the same for someone who is white. And, in America, it never has been,” said Virgil Hayes, advocacy and program manager with the N.C. Harm Reduction Coalition.

“Not everybody has the same level of access to these [treatment] services, and the reason why is a criminalization of certain populations. Unfortunately, this falls in lockstep with historical data that shows that not all drug users have been treated the same in America.”

In 1986, the Congress passed the Anti-Drug Abuse Act which established mandatory minimum sentences for different quantities of cocaine possession. “Congress also established much tougher sentences for crack cocaine offenses than for powder cocaine cases,” according to the ACLU. “For example, distribution of just 5 grams of crack carries a minimum 5-year federal prison sentence, while for powder cocaine, distribution of 500 grams – 100 times the amount of crack cocaine – carries the same sentence.”

African Americans were more likely to use crack cocaine, while white people were more likely to use powder cocaine. As awareness has grown, there are now law enforcement diversion programs which allow some drug users to avoid arrest if they enter into addiction treatment.

“We need to increase programs like the law enforcement-assisted diversion, and make sure there are people of color being invited into those,” said Michelle Mathis, co-founder of Olive Branch Ministry, a N.C. faith-based, harm reduction organization that focuses on outreach to people using drugs, the homeless population and the LQBTQ community.

“If we know that a large percent of people who are locked up for drug-related crimes are black and brown, why wouldn’t we have those services within jails and prisons?”