Overdose deaths are rising among Black and Indigenous Americans

Experts say responses such as mobile and mail-order safety supplies are needed

The recent decline in overdose deaths hides a tremendous disparity by race: Deaths have fallen only among white people while continuing to rise among people of color, according to a new Stateline analysis of federal data.

Health experts in nonwhite communities say they’re finding strategies that work in their areas, but that they still struggle for recognition and funding to address the problems, especially among Black and Native people.

In all, nearly 5,000 more people of color died from overdoses in 2023 than in 2021, while deaths among white people dropped by more than 6,000, according to the analysis of provisional data from the federal Centers for Disease Control and Prevention.

As of early this year, based on partial counts, Black and Native people remain the hardest hit, having earlier in the pandemic surpassed white rates. Hispanic and Asian people are still experiencing more overdose deaths as well.

White people had the highest rate of overdose deaths in 2019, before the pandemic, at 25.4 deaths for every 100,000 people in the U.S. population. But rates for Black and Native people quickly surpassed white rates and continued to grow as white rates declined between 2021 and 2023. In 2023, the death rates were 49.5 and 39.8 per 100,000 for Black and Native people, respectively.

Tracie Gardner, co-director of the National Black Harm Reduction Network, said Black and Native people often have trouble navigating white-dominated institutions, including many harm reduction agencies. Such agencies need to have more people of color in leadership positions to gain the trust of Black, Native and other people who use drugs, she said.

“It is our contention that Black harm reduction isn’t about drug use, it’s about the harms of not being a white person in this country,” Gardner said. “The only people doing worse or as poorly are Native Americans.”

Different trends

Between 2021 and 2023, overdose deaths among white people dropped in all but a dozen states, most of them in the West. But few states saw any decline in deaths among Black or Native American populations. Deaths among Black people did decline, however, in Indiana (-75), the District of Columbia (-29) and Illinois (-22), while deaths among Native people declined in North Carolina (-34), Colorado (-11) and North Dakota (-9).

Connecticut was one of the few states to see a small rate drop among its Black residents. There was no change in the number of overdose deaths, but the Black population grew between 2021 and 2023.

The Connecticut Harm Reduction Alliance is working to bring more harm reduction tools to the Black community and others, with 100 mobile kits available at a moment’s notice.

Most recently, staff started going to meet people leaving detox programs, also known as withdrawal management, when they choose to leave early and are at especially high risk of overdose.

“The message is, ‘Even though this didn’t work out, we care about your welfare, we care about your safety, we want to see you come back,’” said Mark Jenkins, the alliance’s executive director.

Too few services are specifically designed for the Black community, Jenkins said, even though data shows that the overdose crisis is hitting that population the hardest.

“We know that this disproportionately affects people of color, and we’re right out there where people need to see us,” he said of his organization’s approach. “A lot of our people don’t access services if they’re not right there in their path.”

A lack of funding

The overdose death numbers for American Indian and Native Alaskan people may be even higher than the Stateline analysis indicates, because Native people often are misidentified in death certificates, said Philomena Kebec, an attorney and member of the Wisconsin-based Bad River Band of Lake Superior Chippewa.

“These numbers about the impact on tribal and Alaska Native individuals are really stark,” Kebec told Stateline.

Many tribes struggle to provide overdose-halting naloxone and other medications because of chronic underfunding for health services, Kebec, who also is a fellow on addiction and overdose at Johns Hopkins Bloomberg School of Public Health, said on a Brookings Institution podcast last month.

But increasingly, tribes are turning to mobile programs not unlike Connecticut’s. The Confederated Tribes of Grand Ronde in Oregon is adapting buses to help people get methadone and buprenorphine that help curb opioid withdrawal symptoms.

Kebec said in an interview that her own tribe in Wisconsin began a mail-order naloxone program using private donations, but added it could do more with state funding that has yet to be approved.

“We have programming that’s really keyed into how things have to happen in rural communities. We have a lot of people who have transportation issues, so we have to come to them,” she said.

Tribes and helpers need more funding for research to find root causes and more timely information from hospitals to find overdose outbreaks quickly and intervene, she said. It’s a need everywhere, but means even more in Native communities, which are often spread out in rural areas.

In the Black community, men older than 55 are especially hard hit, said Gardner, of the National Black Harm Reduction Network. She noticed their deaths start to increase in the mid-2010s, when she served as New York state’s assistant secretary of health, and later realized those deaths were “the canary in the coal mine” that signaled deadly fentanyl’s infiltration into supplies of other drugs.

During the pandemic, “older [Black] men lost their communities, their family supports. There are some men who became homeless and there was no safety network,” Gardner said. “Plus, men still associate going out and getting health care with a woman’s thing. A lot of care is geared to women.”

Dr. Edwin Chapman, a District of Columbia physician whose practice serves many older Black men who use drugs, said that like others trying to help Black and Native people, he’s had trouble getting funding. His innovations include early use of buprenorphine to curb opioid cravings.

“There has been more pushback from local officials than help,” Chapman said.