SAFE GC Coalition: Older Black Men Impacted More By Opioid Epidemic

Saturday, August 31, was International Overdose Awareness Day, when individuals collectively remember those who have lost their lives to drug overdose, support those who grieve those losses, and offer encouragement to those who seek recovery from addiction. It is also an opportunity to share new knowledge about the overdose crisis and strategies for confronting it. Provisional data from the CDC show that, overall, overdose deaths dropped by 7.5% in the 12 months ending March, 2024, the largest decline in decades. It is cause for optimism however, for some people, greater escalation of overdoses continue.

Recently, the New York Times highlighted the tragic epidemic of overdose deaths among older Black men in Baltimore. It is a city that has been especially hard-hit by the overdose crisis, but the trend is being seen nationwide. Although white and Black people use drugs at similar rates, fatal overdoses have escalated in Black people at a much higher rate than in other groups over the past decade, and multiple recent studies have documented especially high rates of overdose deaths among older Black men.

Fentanyl, often in combination with stimulants, is driving increased overdose deaths in most demographic groups. In all groups, men are at greater risk of overdose than women, but additional factors, including age-related health disparities, social isolation, and lifetime exposure to structural racism, may be colliding to produce the rise in overdoses among older Black men especially, and it points to the urgent need for intervention.

A National Institute on Drug Abuse (NIDA) analysis found that between 2015 and 2023 (provisional data), there was a nearly 5-fold increase in overdose deaths among non-Hispanic Black men 55 and older. In 2023, deaths in that demographic category were nearly triple the national average for that age group. The largest proportion of these deaths, and the steepest increases, involved fentanyl and cocaine. The overdose rate in older Black men is markedly higher than that for Black men overall.

An increase in drug use and drug problems is being seen in older people of all races and ethnicities. Over the past two decades, substance use treatment admissions have increased among people aged 50 and over. In older adults, the risk of problematic opioid use is raised by chronic illness, and pain may be an especially important factor. Chronic pain is prevalent among older adults, and treatment for pain is less effective in this age group than it is in younger people; it negatively impacts quality of life and is a risk factor for cognitive decline and premature death.

As people age, they may start to lose partners and social contacts. A recent National Academies report identified social isolation as a major contributing factor to illness and poor quality of life in older people; it particularly impacts men, who tend to have fewer social supports in later life than women. Loneliness and social isolation are well-known risk factors for substance use, and in an analysis of substance use patterns among older people with varying degrees of social connectedness and perceived loneliness, those who lived alone and felt lonely had the highest rates of nonmedical drug use. Although Black and Hispanic older adults have lower odds of social isolation than white older adults, as well as lower rates of alcohol use, one analysis of overdose deaths among middle-aged and older adults in Illinois identified a common profile of socially isolated, predominantly Black men who had alcohol in their system when they died.

Health and other social disparities likely contribute to escalating overdose rates among older Black men. Black people face discrimination and implicit bias in healthcare settings, including significantly longer wait times for emergency treatment of health problems. Black patients tend to be undertreated for pain, compared to white patients. Such discrimination goes along with other social determinants of health including under-resourced urban environments, housing instability, and food insecurity that may contribute to higher rates of premature mortality and a higher burden of chronic illnesses. Excess mortality from causes including heart disease, cancer, assault, cerebrovascular disease, and diabetes is also higher among Black men.

Discrimination takes a toll on mental health. An analysis of data from the National Epidemiologic Survey on Alcohol and Related Conditions found that discrimination against Black people was associated with higher odds of illicit drug use. Along with other minoritized groups like American Indians, Black people are less likely than white people to engage or remain in substance use treatment.

Historically, prevention research has mainly focused on children, adolescents, and young adults, but along with the rise in opioid-related overdoses in older individuals in most racial and ethnic groups, increased use of other drugs like cannabis in older adults highlights the need for different kinds of interventions. This could include interventions to prevent opioid misuse or the transition from use to misuse specifically in older adults taking opioids for chronic pain. It might also include public-health interventions aimed at addressing social isolation and loneliness in older people, which could have benefits for a wide range of physical and mental health outcomes beyond substance use and its consequences.

Ending the overdose epidemic, especially for the hardest-hit groups like older Black men, will not be easy. It will require coordinated work involving health service providers, community coalitions, policy makers, and—critically—people with lived and living experience of substance use. Researchers, too, will be essential, both for developing new and improved interventions and demonstrating how they can be effectively deployed so that they reach the people who need them.

SAFE is the only alcohol and substance use prevention agency in the City of Glen Cove. Its Coalition is conducting an opioid prevention awareness campaign entitled. “Keeping Glen Cove SAFE,” to educate and update the community regarding opioid use and its consequences. To learn more about the SAFE Glen Cove Coalition please follow us on www.facebook.com/safeglencovecoalition or visit SAFE’s website to learn more about the Opioid Epidemic at www.safeglencove.org.