A new report from the Centers for Disease Control finds US overdose
deaths rose significantly for people of color between 2019 and 2020.
As John Yang reports, the CDC says the synthetic opioid fentanyl
is largely to blame, combined with other disruptions to treatment
and prevention during the pandemic.
On the while overall overdose deaths spiked by 30% during that period
among black Americans. The increase was 44% among Native Americans
and Alaska natives 39%. That's compared with a 22% increase among
white Americans similar to the rates among Asian Americans and Pacific
Islanders and Hispanics.
Dr Edwin Chapman as a physician in Washington, D C. Who specializes
in treating addiction, Dr. Chapman. Thanks for being with us, we've
heard the aggregate numbers. How does that track with what you see
in your clinic? Very close to what we're seeing here in Washington
D c. We've actually seen
A. We saw 40% increase in overdose, Desperate 19 and
2020. And then we saw another four or 5% increase between 20 and
21. So our overall increase since 2019 has been about 50%
in in the District of Columbia, so those those numbers are very close
and in your practice what's driving those numbers? What's driving
that increase? So we've known for
Sometimes that
Our population, which is 95% African American, even though in terms
of overdose deaths, even though in the district of Columbia, we account
for only 46% of the population. But the difference is that our epidemic
started with street drugs. Uh, 40 50 60 years ago with heroin.
But in 2014 that heroin transition to fentanyl, So we start so 20%
fentanyl in 2015, and it gradually increased over the next five years
to now, we're saying 95% fentanyl in our street drugs and fentanyl
is 50 to 100 times more potent.
Then, uh, then then morphine.
And I just want to make sure I'm clear on this is this the drug users
are seeking out fentanyl or that the fentanyl is mixed into the street
drugs. Well, it goes, it goes both ways. Uh, initially, it was mixed
in
and subsequently there were those who did seek out, uh, more potent
form.
But unfortunately, uh, with fentanyl being, uh, so much stronger
than heroin, or the typical pills that people were overdosing and
dying, So we're actually seeing a Darwinian, uh, evolution, so to
speak, Uh, those who are able to tolerate higher doses of
Of drugs just by their genetics and by luck are surviving.
And those are the ones that we're seeing in treatment. Dr. Chapman,
are you seeing any other changes in the in the patients that you're
seeing is the age, for instance of your average patient changing
Absolutely. So. Five years ago, we did a survey and the average age
of our patients was about 50 to 70% male 30% female. Uh,
we actually because it's an older population. 10 to 12% were testing
positive for HIV, uh and about 50%. We're testing positive.
For hepatitis C. So since that time the age has increased to an average
of about 60 at the present time.
And what effect does that have on on on overdose, deaths and and
treatment? So again, you're now talking about people who have other
chronic diseases, diabetes, hypertension, uh, as well mixed in with
their opioid use, And and, of course, some of their mental health
issues. Is there in this sort of racial disparity in the increase
it does does the access to treatment.
Play a role in this
Absolutely, uh, just by structure. African American physicians are
only 5%. And then when you look at psychologist only 4% psychiatrists
to percent, So we're dealing with those structural issues and on
top of those structural issues, we we also have some public policy
issues that have to be addressed.
And has the disparity The widening inequality that we've seen during
the pandemic. Has that had an effect? Yes. So So all of this is really
when we look at it as a whole, Uh, we can say that the pandemic really
is acting as a barometer for our overall health care system.
We can see these structural and public policy issues that have gone
for centuries, in fact, uh, coming to the forefront, and they're
exacerbated by housing issues, transportation issues, so our patient
population because they've been involved in drug use for so many
years.
Are disenfranchised from the community disenfranchised from families,
So we have a very high homeless population. What are the changes
you'd like to see that would help you treat your patients.
So our approach has been, uh, really to a team based approach, and
we realize that 80% of the outcomes are related to things outside
of the doctor's office outside of the hospital, so we really need
to have this community education. We need to have advocacy in the
community.
Uh, legal support to oversee to make sure that patients are getting
the type of treatment that they need. And of course, we need to integrate
substance abuse, mental health and primary care services. Because
these patients have the same issues as everyone else. The fact is
that they've had so many difficulties, including their involvement
with the criminal justice system that have to be reversed.
Addiction specialist Dr Edwin Chapman. Thank you very much. Thank