Racial Disparities in the Opioid Epidemic

Miranda Fritz

SCHC321: The Development of Modern Medicine, 1800-present

Dr. Burke Dial

November 10, 2023

1

Introduction

The historical significance of opium in pain management and surgical interventions has

marked a pivotal chapter in medical history, enhancing patient comfort and well-being. 1

However, the transformative journey of opium has taken an alarming turn, evolving from a

therapeutic asset to a recreational substance and, consequently, contributing to the widespread

challenges of opioid addiction.2 This paper navigates through the intricate journey, exploring the

historical context of opium use and its contemporary consequences.

As the opioid epidemic unfolds, it becomes increasingly apparent that its repercussions

are not uniformly distributed among diverse communities. This paper aims to highlight the

disproportionate impact experienced by minority populations, with a specific emphasis on non-

Hispanic Black communities. The escalation of opioid addiction in urban settings, characterized

by economic hardships and limited access to addiction treatment, compounds the challenges

faced by these communities. The ensuing argument posits that addressing racial and

socioeconomic disparities in opioid addiction necessitates a comprehensive and equitable

approach.

The exploration encompasses mortality rate differentials, disparities in treatment access,

the pervasive impact of stigma, and the instrumental role of insurance policies. Through this

analysis, the research emphasizes the urgent need for implementing strategies that ensure equal

1. F Aragón-Poce, F, E Martı́nez-Fernández, C Márquez-Espinós, A Pérez, R Mora, and

1

L. M Torres. “History of Opium.” International Congress Series, The history of anesthesia, 1242
(December 1, 2002): 19.
2
2. Jonathan Duff, Wen Shen, Lianna Rosen, and Joanna Lampe. “The Opioid Crisis in
the United States: A Brief History.” Congressional Research Service (CRS), (November 30,
2022).
2

access to addiction care for individuals across all racial and cultural backgrounds. In essence, this

research argues for the adoption of equitable strategies to confront and mitigate the

disproportionate impact of opioid addiction on minority populations, envisioning a future where

all communities receive the support required to effectively combat this pervasive public health

crisis.

Opioid Use and Addiction

Throughout history, opium has been esteemed for its well-recognized advantages in the

domains of pain management and surgical analgesia, greatly enhancing the comfort of patients

during medical procedures.3 Its properties rendered it an indispensable asset within the medical

field, ensuring that patients experienced reduced suffering during surgeries and other medical

interventions.4 However, opium underwent a profound transformation over time, shifting from

its role as a therapeutic tool for pain relief to becoming a recreational substance, resulting in a

surge of addiction-related issues. The use and misuse of opioids is not a recent issue; in fact it

has been going on since early wars.5 Opium and its derivatives played a crucial role in pain

management, medical crisis treatment, and the provision of relief to wounded soldiers,

3.George B. Stefano, Nastazja Pilonis, Radek Ptacek, and Richard M. Kream.

3

“Reciprocal Evolution of Opiate Science from Medical and Cultural Perspectives.” Medical
Science Monitor : International Medical Journal of Experimental and Clinical Research 23
(June 13, 2017): 2893.
4
4. Stefano et al., 2892.

5. David F Musto M.D., “Drug Abuse Research in Historical Perspective.” In Pathways

5

of Addiction: Opportunities in Drug Abuse Research. National Academies Press (US), (1996):
285.
3

underscoring the essential role opium has played in the realm of healthcare and pain

management, particularly in times of military conflict.6

A discrete-time survival analysis focused on the transition from pharmaceutical opioids

to heroin initiation in suburban and exurban communities.7 The findings reveal that many

individuals who initiated heroin use had prior exposure to prescription opioids following

legitimate medical treatment, often for pain management. The shift from prescribed medications

to illicit drugs occurred due to multiple factors, including the increasing cost of prescription

opioids and the illicit drug's affordability, as well as the perception of a more potent high from

heroin.8 Furthermore, the study highlights the role of geographical factors in this transition,

pointing to specific neighborhoods where heroin use surged in response to economic hardships

and a lack of access to addiction treatment.9 This study places a spotlight on the current

challenges associated with opium's addictive nature, its evolution from prescribed medications to

illicit drugs, and the communities that demonstrate these trends. Overall, the evolving role of

opium, from its historical significance in pain management to its transition into a recreational

substance, is extremely important to discuss in terms of the evolution of the epidemic.

Disparities in Addiction
6
6. Musto, 285.

7. T. L. Gaines, K. D. Wagner, M. L. Mittal, J. M. Bowles, E. Copulsky, M. Faul, R. W.

7

Harding, and P. J. Davidson. “Transitioning from Pharmaceutical Opioids: A Discrete-Time

Survival Analysis of Heroin Initiation in Suburban/Exurban Communities.” Drug and Alcohol
Dependence 213 (August 1, 2020): 2.
8
8. Gaines et al., 3.
9
9. Gaines et al., 3.
4

A case study conducted in Maryland provides valuable insights into the evolving

landscape of opium use. This extensive study delves into the rising role of prescription drugs as a

gateway to injection drug use and the associated mortality in Baltimore, Maryland. 10 The

research illuminates how certain neighborhoods in Baltimore experienced a surge in prescription

opioid misuse, often tied to the management of chronic pain.11 This increased misuse of

prescription opioids, such as OxyContin and Vicodin, paralleled a growing trend in the use of

non-prescribed opioids like heroin, indicating a shift from legal and medically supervised opioid

use to illicit and potentially perilous consumption.12 Furthermore, the study uncovers specific

socioeconomic challenges faced by individuals who transition from prescription opioids to illicit

drugs, shedding light on the role of economic hardship, limited access to addiction treatment, and

reduced educational opportunities in this shift.13 Ultimately, the increased use of opioids as

prescribed by a physician is associated with an increased use of illicit injectable drugs.

Further exploration of opioid addiction unveils a complex landscape characterized by

distinct disparities among different racial and ethnic groups. There are alarming contrasts in

opioid use rates and opioid overdose death (OOD) rates between racial and ethnic communities. 14

10
10. Javier A. Cepeda, Jacquie Astemborski, Gregory D. Kirk, David D. Celentano,
David L. Thomas, and Shruti H. Mehta. “Rising Role of Prescription Drugs as a Portal to
Injection Drug Use and Associated Mortality in Baltimore, Maryland.” Edited by Barrot Hopkins
Lambdin. PLOS ONE 14, no. 3 (March 4, 2019): 2.
11
11. Cepeda et al., 3.
12
12. Cepeda et al., 8.
13
13. Cepeda et al., 9.

14. Debra Furr-Holden, Adam J. Milam, Ling Wang, and Richard Sadler. “African
14

Americans Now Outpace Whites in Opioid-Involved Overdose Deaths: A Comparison of

Temporal Trends from 1999 to 2018.” Addiction 116, no. 3 (2021): 678.
5

For instance, recent research revealed that African Americans now outpace whites in opioid-

involved overdose deaths, marking a significant shift in the demographics of opioid-related

fatalities.15 A study compared temporal trends from 1999 to 2018 that highlight the statistically

significant increase in OOD among African Americans compared to their White counterparts

during the 2012-2018 time period.16 Factors such as opioid use and misuse, tolerance and

dependence, polysubstance use, unregulated drug supply (notably synthetic opioids like

fentanyl), reduced tolerance after abstinence, and social determinants of health all play a role in

the risk of opioid overdose.17 This temporal analysis emphasizes the need for tailored

interventions that address the specific challenges faced by Black Americans in combating opioid

addiction and overdose, as they are disproportionately affected by the effects of opioid use and

its consequences.

The opioid epidemic disproportionately affects African American communities,

particularly those in urban areas, where a convergence of factors compounds the risks associated

with opioid misuse. Urban centers, including cities like DC, Detroit, Chicago, and Baltimore,

experience significantly higher rates of opioid-related deaths compared to other regions. 18 Within

these urban environments, African Americans face a multitude of challenges, including limited

access to healthcare, transportation deficiencies, and housing instability, creating barriers to

15
15. Furr-Holden et al., 679.
16
16. Furr-Holden et al., 679.
17
17. Furr-Holden et al., 679.

18. Marjorie C. Gondré-Lewis, Tomilowo Abijo, and Timothy A. Gondré-Lewis. “The

18

Opioid Epidemic: A Crisis Disproportionately Impacting Black Americans and Urban

Communities.” Journal of Racial and Ethnic Health Disparities 10, no. 4 (August 1, 2023):
2042.
6

proper treatment and recovery.19 Economic disparities further the crisis, as many urban Black

individuals grapple with severe economic challenges and housing instability, hindering their

ability to maintain stable living conditions conducive to recovery.20 Moreover, the urban setting

introduces obstacles such as healthcare deserts, where access to medical facilities is limited.

This, combined with fewer treatment centers and potential lack of private insurance, creates a

healthcare gap, leaving urban Blacks with fewer resources to combat the epidemic effectively. 21

The opioid epidemic's impact on Black communities is complex, influenced by both racial

disparities and the challenges posed by urban environments, and requires a comprehensive public

health response is to combat these specific obstacles.

Disparities in Mortality

A comprehensive examination of opioid use disorder (OUD) treatment capacity across

the United States reveals stark racial disparities in mortality among Black communities. The

trend wherein the capacity to provide essential medications for OUD, specifically methadone and

buprenorphine, is significantly influenced by the racial/ethnic composition of a community. 22

Between 2009 and 2018, the age-adjusted death rates for opioid-involved overdose increased by

a staggering 289% among African American adults.23 The racialized treatment landscape raises

19
19. Gondré-Lewis, Abijo, and Gondré-Lewis, 2042.
20
20. Gondré-Lewis, Abijo, and Gondré-Lewis, 2044.
21
21. Gondré-Lewis, Abijo, and Gondré-Lewis, 2044.

22. William C. Goedel, Aaron Shapiro, Magdalena Cerdá, Jennifer W. Tsai, Scott E.
22

Hadland, and Brandon D. L. Marshall. “Association of Racial/Ethnic Segregation With

Treatment Capacity for Opioid Use Disorder in Counties in the United States.” JAMA Network
Open 3, no. 4 (April 22, 2020): 2.
23
23. Goedel et al., 7.
7

profound concerns about equitable access to life-saving medications. Methadone availability is

found to be higher in counties where African American and Hispanic/Latino residents are

unlikely to interact with white residents.24 Conversely, buprenorphine availability is higher in

counties where white residents are unlikely to interact with African American or Hispanic/Latino

residents.25 These disparities not only reflect a pattern of racial segregation but also illuminate a

systemic barrier that restricts Black individuals' access to evidence-based OUD treatment

options. The differential availability of OUD medications across U.S. counties is identified as an

additional manifestation of racism within healthcare services, necessitating urgent and systemic

changes.26 Ultimately, the study underscores the imperative of ensuring equal accessibility to

both methadone and buprenorphine for all individuals, particularly those in Black communities,

who are disproportionately affected by the opioid epidemic.

A small step toward addressing these disparities lies within the elimination of the X-

waiver. The "X-waiver" was a regulatory requirement that healthcare providers in the United

States needed to obtain to prescribe buprenorphine for opioid use disorder (OUD) treatment.27 It

involved additional training, administrative criteria, and patient limits. The elimination of the X-

waiver requirement for prescribing buprenorphine represents a crucial advancement in

addressing the opioid epidemic, particularly in relation to non-Hispanic Black communities. 28

This regulatory change plays a significant role in improving access to opioid use disorder (OUD)
24
24. Goedel et al., 6.
25
25. Goedel et al., 7.
26
26.Goedel et al., 8.

27. Henry Rosen, and Chinazo O. Cunningham. “Time to End Racial Disparities in
27

Buprenorphine Access.” American Journal of Public Health 113, no. 10 (October 2023): 1083.
28
28. Rosen and Cunningham, 1083.
8

treatment and reducing disparities in healthcare access. The X-waiver was a substantial obstacle

that limited the number of healthcare providers who could prescribe buprenorphine, hampering

its availability to individuals seeking OUD treatment.29 By removing this requirement, a more

extensive pool of qualified providers can now offer buprenorphine treatment. Historically, the

regulation of buprenorphine has favored predominantly white, middle- and upper-income

communities, with limited access for BIPOC communities and economically disadvantaged

areas.30 By eliminating the X-waiver, the benefits of buprenorphine treatment can extend more

equitably across racial and socioeconomic lines, reducing existing disparities in OUD care.

Disparities in Treatment Access

The intersection of race and opioid use disorder treatment is undeniable, as being a

minority is associated with a decreased likelihood of treatment referral from medical

professionals, receiving medication-assisted treatment, and completing treatment due to

structural and racial factors. A quantitative analysis draws attention to the profound racial

disparities within the treatment landscape of opioid use disorder (OUD) and their profound

implications for Black populations.31 This investigation reveals a stark contrast in how

individuals of minority racial backgrounds, including Black Americans, are less likely to be

referred to OUD treatment by medical professionals when compared to instances of self-referral

or referrals by family members.32 The data highlights the concerning impact of implicit racial

29
29. Rosen and Cunningham, 1084.
30
30. Rosen and Cunningham, 1084.

31. Rebecca M. Entress, “The Intersection of Race and Opioid Use Disorder Treatment:
31

A Quantitative Analysis.” Journal of Substance Abuse Treatment 131 (December 1, 2021): 2.

32
32. Entress, 4.
9

biases, Black individuals encounter barriers in seeking timely and adequate access to OUD

treatment, resulting in potential delays and inequities in care.33

In terms of treatment completion, the data reflects that White individuals exhibit a

substantially higher likelihood of leaving treatment due to the successful completion of the

treatment episode when compared to all other demographic categories.34 Conversely, Black

individuals are significantly less likely to complete their OUD treatment, which could be

attributed to systemic barriers or the absence of culturally appropriate care. 35 Black individuals

often encounter obstacles such as delayed access to care, unequal opportunities for medication-

based treatment, and lower rates of treatment completion, all of which contribute to enduring

health disparities.36 These findings underscore the urgent need for the development of more

equitable, culturally sensitive, and unbiased treatment strategies specifically designed to address

OUD within Black populations.

Stigma

Stigma associated with Medication for Opioid Use Disorder (MOUD) is a significant

barrier to addiction care. Negative attitudes toward MOUD often discourage individuals from

seeking treatment or adhering to it, particularly in Black communities. The historical bias and

discrimination surrounding drug use have created a dichotomy where some individuals are seen

33
33. Entress, 6.
34
34. Entress, 3.
35
35. Entress, 3.
36
36. Entress, 4.
10

as "patients" and others as "criminals.”37 The perception of Black individuals struggling with

addiction as "criminals" plays out in various settings, including healthcare. This stigma leads to

punitive approaches rather than medical responses, limiting access to essential care. 38

High treatment costs are another barrier that reinforces stigma and affects Black

communities disproportionately.39 Stigmatizing attitudes of clinicians, pharmacists, and other

professionals can discourage Black individuals from seeking treatment. The perception that they

will not receive the same level of care or empathy as their white counterparts contributes to

delays in seeking addiction treatment, resulting in more severe symptoms and increased overdose

rates.40 Complex red tape payer policies like "fail first" and prior authorization further hinder

access to quality addiction care.41 These policies add layers of bureaucracy, making it

challenging for Black individuals to access the care they need, and the lack of treatment options

for individuals with co-occurring disorders compounds these issues.

Equitable Approaches

To make addiction treatment more equitable, there are some key changes that need to be

made, beginning with culturally competent care. The data highlights the need for culturally,
37
37. Jessica N. Hulsey, “Toward Improved Addiction Treatment Quality and Access for
Black Patients.” American Journal of Public Health 112, no. S1 (February 2022): S21.
38
38. Hulsey, S21.

39. O. Trent Hall, Ayana Jordan, Julie Teater, Kamilah Dixon-Shambley, Monique E.
39

McKiever, Mikyung Baek, Stephanie Garcia, Kara M. Rood, and David A. Fielin. “Experiences
of Racial Discrimination in the Medical Setting and Associations with Medical Mistrust and
Expectations of Care among Black Patients Seeking Addiction Treatment.” Journal of Substance
Abuse Treatment 133 (February 1, 2022): 5.
40
40. Hall et al., 5.
41
41. Hall et al., 5.
11

racially, and ethnically appropriate care.42 This includes training healthcare providers to be

culturally competent, ensuring that the sociodemographic characteristics of providers match the

patients they serve, and addressing issues of implicit bias.43 This can help build trust and improve

patient-provider relationships, ultimately leading to more equitable care. Providing telehealth and

similar options for addiction treatment can help people overcome barriers related to stable

housing, transportation, and childcare.44 This is especially critical for individuals from racial and

ethnic minority groups, who may face additional challenges in accessing in-person services.

Incorporating culturally appropriate traditional practices, spirituality, and religion into evidence-

based treatment can improve participation and retention among racial and ethnic minority

groups.45 These practices should be offered in languages other than English to ensure inclusivity.

Creating support groups to reduce stigma and mistrust is essential. High rates of stigma toward

people who use drugs, documented among healthcare providers and the public, can limit access

to overdose prevention education and naloxone.46 Recovery support groups should be culturally

and language appropriate, addressing the adverse effects of stigma and discrimination. Providing

structural support such as stable housing, transportation assistance, and childcare can address the

socioeconomic factors that may impede access to treatment.47 Wide income gaps, often affecting

racial and ethnic minority groups, should be considered when designing support services.

42. National Center for Injury Prevention and Control. “Achieving Health Equity
42

Around Overdoses | Feature Topics | Drug Overdose,” (October 19, 2022): 2.

43
43. National Center for Injury Prevention and Control, 2.
44
44. National Center for Injury Prevention and Control, 1.
45
45. National Center for Injury Prevention and Control, 2.
46
46. National Center for Injury Prevention and Control, 5.
47
47. National Center for Injury Prevention and Control, 3.
12

On a broader level, addressing the criminalization of substance use disorders is crucial.

Public health and public safety partnerships can help people leaving the criminal justice system

access care for substance use disorders rather than facing punitive measures. Linking people to

care and recovery through a variety of settings and peer support navigators can improve

treatment outcomes.48 Clinicians and health systems should play a key role in this process, and

cultural competence should be embedded across clinical settings. Access to programs that

address past and prevent future trauma and other risk factors for substance use is important, as

harm from adverse childhood experiences can increase the risk of substance use disorders.49 By

implementing these actions, healthcare systems and policymakers can work towards more

equitable addiction treatment. The focus should be on ensuring that all individuals, regardless of

their racial, ethnic, or cultural background, have the opportunity to access high-quality, culturally

appropriate care and support for substance use disorders.

Insurance & The Affordable Care Act

A discussion regarding improving access to treatment would not be complete without

bringing up the critical role that insurance plays in access to medication and treatment for OUD.

The implementation of the Affordable Care Act positively correlated with an increase in

medication for OUD (MOUD) particularly among Black clients, reducing treatment disparities

48
48. Brendan Saloner, Emma E. McGinty, Leo Beletsky, Ricky Bluthenthal, Chris Beyrer,
Michael Botticelli, and Susan G. Sherman. “A Public Health Strategy for the Opioid Crisis.”
Public Health Reports 133, no. 1_suppl (November 2018): 304.
49
49. Saloner et al., 304.
13

between Black and White clients.50 Furthermore, the ACA led to Medicaid expansion, which

significantly increased admissions to substance use treatment programs.51 Given that Medicaid is

the largest payer for mental health services in the United States, including substance use

treatment, this expansion had a considerable impact on access to care.52 The combined data

highlights the substantial impact of the ACA on improving access to OUD treatment, particularly

among Black populations. However, several states, primarily in the Southeast, did not adopt the

ACA's Medicaid expansion. These states had a high percentage of the U.S. Black population,

contributing to unequal access to substance use treatment services, which includes OUD

treatment.53 The ACA's provisions, including Medicaid expansion, played a vital role in reducing

racial disparities in MOUD utilization and increasing admissions to substance use treatment

programs.

Conclusion

Addressing opioid addiction disparities is a pressing concern. Historical roots of opium

highlight its transformation into a recreational substance and the resulting challenges. Disparities

persist, with Black communities bearing a disproportionate burden. Solutions include eliminating

the X-waiver, which enhances access to treatment, especially in underserved communities.

50. Jevay Grooms, and Alberto Ortega. “Racial Disparities in Accessing Treatment for
50

Substance Use Highlights Work to Be Done.” USC Schaeffer (blog), April 29, 2022.
51
51. Grooms and Ortega.

52. Natrina Johnson, Sugy Choi, and Carolina-Nicole Herrera. “Black Clients in
52

Expansion States Who Used Opioids Were More Likely to Access Medication for Opioid Use
Disorder after ACA Implementation.” J Subst Abuse Treat. 133 (February 2022): 7.
53
53. Johnson, Choi, and Herrera, 8.
14

Racial disparities in treatment access underscore the urgent need for equitable, culturally

sensitive strategies. Stigma, treatment costs, and bureaucratic barriers impact Black communities

disproportionately. Telehealth, culturally appropriate practices, support groups, and structural

support can improve access to care and mitigate disparities. Addressing the criminalization of

substance use disorders is crucial, with public health and public safety partnerships playing a key

role.

The implementation of the Affordable Care Act (ACA) positively correlated with

increased medication for opioid use disorder (MOUD) utilization. MOUD utilization among

Black clients increased significantly, reducing treatment disparities between Black and White

clients. Medicaid expansion under the ACA substantially increased admissions to substance use

treatment programs, enhancing access to care, especially in states that adopted expansion.

However, some states, primarily in the Southeast, did not adopt Medicaid expansion, leading to

unequal access to substance use treatment services.

In conclusion, the imperative for equitable systems becomes evident when addressing the

disparities experienced by the Black community in combating the opioid epidemic. It

underscores the necessity to establish fair and just frameworks that ensure every individual,

irrespective of their racial background, has equal access to effective treatment, support, and

resources. Acknowledging and rectifying these disparities is not only a matter of social justice

but a crucial step towards crafting inclusive solutions that can effectively mitigate the impact of

the opioid epidemic within the Black community.

15
16

Bibliography
Aragón-Poce, F, E Martı́nez-Fernández, C Márquez-Espinós, A Pérez, R Mora, and L. M Torres.
“History of Opium.” International Congress Series, The history of anesthesia, 1242
(December 1, 2002): 19–21. https://doi.org/10.1016/S0531-5131(02)00600-3.

Cepeda, Javier A., Jacquie Astemborski, Gregory D. Kirk, David D. Celentano, David L.
Thomas, and Shruti H. Mehta. “Rising Role of Prescription Drugs as a Portal to Injection
Drug Use and Associated Mortality in Baltimore, Maryland.” Edited by Barrot Hopkins
Lambdin. PLOS ONE 14, no. 3 (March 4, 2019): e0213357.
https://doi.org/10.1371/journal.pone.0213357.

Duff, Jonathan, Wen Shen, Lianna Rosen, and Joanna Lampe. “The Opioid Crisis in the United
States: A Brief History.” Congressional Research Service (CRS), November 30, 2022.
https://crsreports.congress.gov/product/pdf/IF/IF12260.

Entress, Rebecca M. “The Intersection of Race and Opioid Use Disorder Treatment: A
Quantitative Analysis.” Journal of Substance Abuse Treatment 131 (December 1, 2021):
108589. https://doi.org/10.1016/j.jsat.2021.108589.

Furr-Holden, Debra, Adam J. Milam, Ling Wang, and Richard Sadler. “African Americans Now
Outpace Whites in Opioid-Involved Overdose Deaths: A Comparison of Temporal
Trends from 1999 to 2018.” Addiction 116, no. 3 (2021): 677–83.
https://doi.org/10.1111/add.15233.

Gaines, T. L., K. D. Wagner, M. L. Mittal, J. M. Bowles, E. Copulsky, M. Faul, R. W. Harding,

and P. J. Davidson. “Transitioning from Pharmaceutical Opioids: A Discrete-Time
Survival Analysis of Heroin Initiation in Suburban/Exurban Communities.” Drug and
Alcohol Dependence 213 (August 1, 2020): 108084.
https://doi.org/10.1016/j.drugalcdep.2020.108084.

Goedel, William C., Aaron Shapiro, Magdalena Cerdá, Jennifer W. Tsai, Scott E. Hadland, and
Brandon D. L. Marshall. “Association of Racial/Ethnic Segregation With Treatment
Capacity for Opioid Use Disorder in Counties in the United States.” JAMA Network
Open 3, no. 4 (April 22, 2020): e203711.
https://doi.org/10.1001/jamanetworkopen.2020.3711.

Gondré-Lewis, Marjorie C., Tomilowo Abijo, and Timothy A. Gondré-Lewis. “The Opioid
Epidemic: A Crisis Disproportionately Impacting Black Americans and Urban
17

Communities.” Journal of Racial and Ethnic Health Disparities 10, no. 4 (August 1,
2023): 2039–53. https://doi.org/10.1007/s40615-022-01384-6.
Grooms, Jevay, and Alberto Ortega. “Racial Disparities in Accessing Treatment for Substance
Use Highlights Work to Be Done.” USC Schaeffer (blog), April 29, 2022.
https://healthpolicy.usc.edu/evidence-base/racial-disparities-in-accessing-treatment-for-
substance-use-highlights-work-to-be-done/.

Hall, O. Trent, Ayana Jordan, Julie Teater, Kamilah Dixon-Shambley, Monique E. McKiever,
Mikyung Baek, Stephanie Garcia, Kara M. Rood, and David A. Fielin. “Experiences of
Racial Discrimination in the Medical Setting and Associations with Medical Mistrust and
Expectations of Care among Black Patients Seeking Addiction Treatment.” Journal of
Substance Abuse Treatment 133 (February 1, 2022): 108551.
https://doi.org/10.1016/j.jsat.2021.108551.

Hulsey, Jessica N. “Toward Improved Addiction Treatment Quality and Access for Black
Patients.” American Journal of Public Health 112, no. S1 (February 2022): S21–23.
https://doi.org/10.2105/AJPH.2021.306664.

Johnson, Natrina, Sugy Choi, and Carolina-Nicole Herrera. “Black Clients in Expansion States
Who Used Opioids Were More Likely to Access Medication for Opioid Use Disorder
after ACA Implementation.” J Subst Abuse Treat. 133 (February 2022): 108533.
doi:10.1016/j.jsat.2021.108533.
Musto M.D., David F. “Drug Abuse Research in Historical Perspective.” In Pathways of
Addiction: Opportunities in Drug Abuse Research. National Academies Press (US),
1996. https://www.ncbi.nlm.nih.gov/books/NBK232965/.

National Center for Injury Prevention and Control. “Achieving Health Equity Around Overdoses
| Feature Topics | Drug Overdose,” October 19, 2022.
https://www.cdc.gov/drugoverdose/featured-topics/overdose-health-equity.html.

Rosen, Henry, and Chinazo O. Cunningham. “Time to End Racial Disparities in Buprenorphine
Access.” American Journal of Public Health 113, no. 10 (October 2023): 1083–85.
https://doi.org/10.2105/AJPH.2023.307388.

Saloner, Brendan, Emma E. McGinty, Leo Beletsky, Ricky Bluthenthal, Chris Beyrer, Michael
Botticelli, and Susan G. Sherman. “A Public Health Strategy for the Opioid Crisis.”
Public Health Reports 133, no. 1_suppl (November 2018): 24S-34S.
https://doi.org/10.1177/0033354918793627.
18

Stefano, George B., Nastazja Pilonis, Radek Ptacek, and Richard M. Kream. “Reciprocal
Evolution of Opiate Science from Medical and Cultural Perspectives.” Medical Science
Monitor : International Medical Journal of Experimental and Clinical Research 23 (June
13, 2017): 2890–96. https://doi.org/10.12659/MSM.905167.