Black, Hispanic Patients Receive MOUD After Opioid-Related Events Less Frequently Than White Patients

Tom Valentino, Digital Managing Editor

05/16/2023

Despite making a similar number of visits to healthcare providers in the 6 months following an opioid-related event, White patients receive medication for opioid use disorder (OUD) up to 80% more frequently than Black patients and up to 25% more frequently than Hispanic patients, according to a recent study by researchers at Harvard T.H. Chan School of Public Health and Dartmouth College.

Findings from the study were published in the New England Journal of Medicine.

Researchers reviewed a random sample of Medicare fee-for-service beneficiaries with disability—a group of Americans who are among the most affected by OUD—who experienced at least 1 acute OUD-related event, such as overdose, infection, or detox admission, between 2016 and 2019. Among the Medicare claims reviewed, researchers identified 25,904 OUD-related events—15.2% of which occurred among Black patients, 8.1% among Hispanic patients, and 76.7% among White patients.

In the 6 months following OUD-related events, Black patients received and filled a prescription for buprenorphine 12.7% of the time. For Hispanic patients, the rate was 18.7%, and among White patients, the rate was 23.3%. Rates for naloxone, the opioid overdose reversal medication, were similar: 14.4% for Black patients, 20.7% for Hispanic patients, and 22.9% for White patients.

In a news release announcing the findings, study lead author Michael Barnett, associate professor of health policy and management at Harvard Chan School, noted that opioid overdoses have been rising more quickly among Black individuals than any other racial group, surpassing overdose rates in the White population for the first time in decades in 2021. Overdose rates in the Hispanic population are up 40% recently, he added.

 “We need to understand barriers to obtaining life-saving addiction treatment for minority populations to address this huge demographic shift and public health crisis,” Barnett said in the release.

 Prescriptions for opioid analgesics and benzodiazepines, meanwhile, were received and filled frequently. Regardless of race, prescriptions for opioid analgesics were received and filled 23% of the time after OUD-related events. Benzodiazepine prescriptions were received and filled by Black patients 23.4% of the time, 29.6% by Hispanic patients, and 37.1% by White patients.

“Skyrocketing rates of overdoses in minority groups are unlikely to shift without a major overhaul in the addiction treatment system,” Barnett said. “Addressing the overdose crisis and racial disparities in addiction will likely require community-specific interventions that engage with minority populations and the clinicians who serve them to reduce stigma and bolster trust.”

Reference

Substantial racial inequalities despite frequent health care contact found in treatment for opioid use disorder. News release. Harvard University T.H. Chan School of Public Health. May 10, 2023. Accessed May 16, 2023.

https://www.hmpgloballearningnetwork.com/site/ap/news/black-hispanic-patients-receive-moud-after-opioid-related-events-less-frequently-white

Addressing Alcohol Use Disorder in African American Youth

Addiction comes in many forms and does not discriminate. However, it’s important to understand its impact on specific populations to develop more targeted and effective strategies aimed at improving health equity. In honor of Black History Month, we will explore alcohol use disorder (AUD) and its impact on African American (AA) youth. We will also discuss the role of research in achieving more equitable health outcomes.


Across the U.S., underage drinking is a serious public health concern. Alcohol remains the most, and often, first substance used among youth. In 2021, nearly 6 million people aged 12 to 20 reported drinking alcohol. Among those, more than half (3.2 million) reported binge alcohol use (SAMHSA, 2023). An estimated 29.5 million people aged 12 and older were diagnosed with an AUD in 2021 including 900,000 youth aged 12-17 (SAMHSA, 2021). Nearly 5% of those youth identified as Black or AA and 3% identified as two or more races (SAMHSA, 2021).

Understanding the development of alcohol behaviors is important to understanding why some adolescents drink. First, alcohol-related cognitions, known as alcohol expectancies (AE), develop as early as age 4 (Smit, et al, 2018). AE significantly influences drinking behaviors. A positive AE is the belief that alcohol leads to more pleasurable outcomes (e.g., being more social) and is associated with increased drinking. In contrast, a negative AE is the belief that alcohol leads to undesirable outcomes (e.g., feeling ill) and is associated with less drinking (Smit, et al, 2018). 

Longitudinal examination of AE and alcohol use outcomes show that AA youth aged 7-10 reported higher positive AE compared to White youth (Banks, et al, 2020). Despite higher positive AE in AA youth, White youth were more likely to use alcohol, suggesting positive AE posed lower drinking risk for AA youth (Banks, et al, 2020). However, even though AAs report later alcohol initiation and lower rates of use, they still have more significant alcohol-related problems compared to Whites. Unfortunately, the lack of diversity in most studies makes it difficult to understand why the relationship between AE, alcohol use, and its consequences differ among racial and ethnic groups. Click here to continue reading.

Recovery & Resiliency - 2023 Black History Month Reflections

By Laurie Johnson-Wade

Co-Founding Director of Lost Dreams Awakening (LDA) Recovery Community

Organization & Peer Recovery CoE Steering Committee Member Recovery Reader Peer Recovery Center of Excellence

February, a month when our nation turns its focus towards Black Excellence and the history of Black citizens of the United States of America, and as I try to celebrate by working on these brief reflections, I must take note that this celebratory month is being eclipsed by the reality that a great number of black citizens still struggle to realize full agency here in the USA; a reality that is substantiated by the most recent public, and traumatic, events that we have collectively witnessed and are now grappling with in 2023.

 Black History Month allows me to reflect on the layers of my identity, something I am always hyper aware of, I’m a black female in substance use disorder (SUD) recovery since 1991, coupled with many other intersectional aspects that make me who I am;  I recognize “resiliency” as an indispensable strength of my life and other Black citizens of our great nation. 

 I would like to offer the following as a gift during Black History Month 2023. This is a briefing that was sent to me from Dr. Ryan Niemiec, at VIA, following the murder of George Floyd (a Black citizen who struggled with Substance Use Disorder) in 2020. Click here to continue reading.

National Women's History Month

A salute to African American Women who have made historical contributions to Substance Use Disorders Treatment and Recovery.

Clara McBride-Hale. "Mother Hale" Founder of Hale House in New York City. Mother Hale housed children prenatally exposed to heroin in the 1960's and 70's, children prenatally exposed to cocaine in the 1980's and 90's and children born HIV positive.

Andrea Barthwell, MD, FASAM. Dr. Barthwell is the former President of The American Society of Addiction Medicine and she served as Director of Demand Reduction at the Office of the National Drug Control Policy under President George W. Bush.

Lonnetta Albright. As former Director of Great Lakes ATTC, Lonnetta helped shift Substance Use Disorders Treatment from the acute care model solely, towards a recovery oriented system of care. Under her leadership Great Lakes ATTC published a monograph series authored by historian William White, MA on recovery management and recovery oriented system of care. This series played a role in helping to shape the future of treatment and recovery services.

Corrie Vilsaint, PHD. Dr. Vilsaint is the principal investigator at the Recovery Research Institute and Center for Addiction Medicine at Massachusetts General Hospital and research fellow at Harvard Medical School. Some of her research focuses includes recovery capital, reducing discrimination among individuals in recovery and racial health equity in remission and recovery.

Ijeoma Achara-Abraham, PsyD. In her role as a consultant, trainer and strategic planner, Dr. Achara-Abraham is one of the nation’s experts in helping cities and states transform their system to a recovery oriented system of care.

Tonier Cain. Tonier is an author, entrepreneur, movie producer and one of the nation’s foremost advocates and speakers on trauma informed substance use disorders treatment.

Anita Bertrand Bradley, LSW, LICDC. Anita is founder of Northern Ohio Recovery Association. NORA is a model program offering a full range of recovery services. Anita's work has been recognized nationally. She is the recipient of Faces and Voices of Recovery, Joel Hernandez Community Recovery Award, she was honored by President Obama 's Administration as a champion of change and Smart Women Magazine, Women who Excel Entrepreneur Award.

Ayana Jordan, MD, PHD. Dr. Jordan's extensive research, educational and clinical work focuses on increasing access to evidence based substance use disorders treatment for Black, Latinx and Indigenous persons of color nationally and abroad.

Dawn Tyus, PHD, LPC. Dawn Tyus is the Principal Investigator of the African American Behavioral Health Center of Excellence, she is also PI and Director of Southeast Addiction Technology Transfer Center at Morehouse School of Medicine.

A Storied Career: Interview with 2021 NAADAC Enlightenment Award Winner, Mark Sanders

Mark Sanders, LCSW, CADC, is the Illinois State Project Manager for the Great Lakes ATTC, MHTTC, and PTTC. Mark is a published author, trainer, educator, and mentor, as well as the founder of the Online Museum of African American Addictions, Treatment, and Recovery and the co-founder of Serenity Academy of Chicago, the only recovery high school in Illinois. 

If you have never attended a training hosted by Mark Sanders, you're missing out. Mark has a unique ability to be at once both energizing and reassuring. His presentations are equal parts inspiration and intellect – a captivating mix of stories, memoire, and facts. He has motivated and educated countless members of the SUD workforce throughout his nearly 40-year career. For these reasons and many more, Mark Sanders, LCSW, CADC, has been selected as the recipient of the 2021 NAADAC Enlightenment Award, the 2021 Community Behavioral Healthcare Association of Illinois Frank Anselmo Lifetime Achievement Award, and the Illinois Association for Behavioral Health’s 2021 Lawrence Goodman Friend of the Field Award.   

The Great Lakes ATTC, MHTTC, and PTTC congratulate our colleague, Mark Sanders, on these well-deserved awards for his many years of exemplary service and leadership. In celebration of his accomplishments, we asked Mark to share his thoughts on the field of SUD recovery services and how he has achieved success throughout his career. Click here to continue reading.

 
 

Lessons Learned From Native American Communities on Recovery

 

November is National Native American Heritage Month. In this post I would like to share lessons we all can learn about addictions recovery from Native American Communities. One commonality African Americans share with Native Americans is centuries of trauma imposed on us by White Americans. As African Americans we experienced 250 years of slavery, Jim Crow Laws, lynchings, police brutality and mass incarceration. Native Americans experienced several hundred years of massacre, their culture and land taken away. As a result of this historical trauma, Native Americans developed the highest alcoholism rate in the world.

Today, some Native Americans tribes are achieving some of the highest recovery rates in the world, by healing historical trauma and returning to the cultures which were taken from them. One group I would like to highlight is White Bison founded by Don Coyhis, by helping tribes return to culture and healing historical trauma, White Bison is helping tribes achieve 40 to 70% recovery rates. 

Canada, our neighbors to the north also have a history of inflicting trauma on First Nation Tribes. There is a documentary called The Honour of All, which tells the story of a First Nation Tribe that went from 100% alcoholism to 95% recovery. They have maintained a 95% recovery rate for over 35 years by returning to culture. 

I once presented at a research conference on Addictions in Canada. All the top U.S. researchers were there. I suggested that the entire conference take a journey to the reservation and learn how a First Nation Tribe has maintained a 95% recovery rate for 35 years. I truly believe that recovery in African American Communities will involve a return to the culture that was stolen from us during chattel slavery.

YOU'LL HANDLE THAT TOO!

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An African American female friend called me and said she relapsed recently. I immediately thought of the words of African American tennis star, the late Arthur Ashe, who contracted HIV through a blood transfusion.. A reporter asked Ashe, “Was Aids the hardest thing you ever had to deal with?” Ashe replied, “The hardest thing I have ever had to deal with is being Black in this society.”

Thinking of Ashe's comments, the trauma my friend has endured in her lifetime and her resilience, I said to her, “You have handled being a Black Woman in America. You will handle this too!”

I listened as my friend shared what led to her return to drug use and we also discussed language. I introduced her to the term reoccurrence of symptoms as an alternative to the term relapse. The term relapse is perceived as negative. Cancer patients don't relapse I suggested, symptoms return. I shared that Women for Sobriety calls a relapse A temporary setback! I shared with my friend the words of writer Johann Hari, “The opposite of addiction is not recovery. Its connection.

My friend smiled and said, I'm going to a meeting today.

Black Opioid Deaths Increase Faster Than Whites, Spurring Calls For Treatment Equity

September 10, 20215:00 AM ET

MARISA PEÑALOZA

 A study published Thursday reveals a growing racial disparity in opioid overdose death rates. Deaths among African Americans are growing faster than among whites across the country. The study authors call for an "antiracist public health approach" to address the crisis in Black communities.

The study, conducted in partnership with the National Institute on Drug Abuse at the National Institutes of Health, analyzed overdose data and death certificates from four states: Kentucky, Ohio, Massachusetts and New York. It found that the rate of opioid deaths among Black people increased by 38% from 2018 to 2019, while rates for other racial and ethnic groups did not rise.

The study used data collected before the coronavirus pandemic began; preliminary data show that overall drug overdoses rose in 2020.

In the earlier waves of the opioid crisis, African Americans had lower rates of overdose deaths than whites, according to another study published last year in the journal Addiction, and Black rates stayed level from 1999 through 2012. However by 2013, white rates began to level off while Black rates began increasing.  The new study from NIDA confirms the trend.

 Click here to continue reading.

Lessons from the Recovery Legacies of Frederick Douglass and Malcolm X

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Mark A. Sanders, LCSW, CADC; Illinois State Program Manager, Great Lakes ATTC, MHTTC, and PTTCPublication Date: Feb 11, 2021

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Frederick Douglass was the first prominent American to recover from alcohol use disorder (White, 2014 ). Douglass's alcoholism was triggered by the trauma he endured in slavery. Douglass believed that alcohol was used to control the slaves. In his autobiography, Douglass stated that the enslaved would be abused Monday through Friday and given alcohol to drink on Saturday as medicine for the abuse (Douglass, 2019 ).  In a speech in Scotland in March of 1846, Douglass stated, "When a slave was drunk, the slaveholder had no fear that he would plan an insurrection. No fear that he would escape to the north. It was the sober thinking slave who was dangerous and needed vigilance of the slaveholder to keep him a slave ( Douglass, 1846)."

Speaking on his own alcohol use, Douglass stated, "I used to drink. I found in me all those characteristics leading to drunkenness." He went on to state, "I have had some experience with intemperance. I knew what it was like to drink with all the ardor of a drunk. Some of the slaves were not able to drink their share. I was able to drink my own and theirs too. (Douglass,1846)."

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Like Douglass, Malcolm X experienced trauma in childhood, which proceeded his substance use disorder. In his youth, Malcolm grew up in Omaha, Nebraska. He grew up in an environment of race riots and lynchings. His father was killed by the Klu Klux Klan, and his mother was placed in an asylum. Leaving a young Malcolm and his sibling to be placed in the child welfare system (Payne and Payne, 2020). If the ACE's test were available in Malcolm's youth, he would have scored high on childhood trauma exposure, a precursor to substance use disorders.

Both Frederick Douglass and Malcolm X achieved long term recovery, although their pathways of recovery differed. Douglass's pathway of recovery was social protest. Refusing to continue to use a drug he believed was used to control the Africans who were enslaved. Malcolm X's recovery story began in prison and is often described as a quantum spiritual awakening. All the urges to use drugs were removed instantly (Haley, 1999). 

Both men became advocates in recovery. Douglass was one of the founders of The Black Temperance movement. Malcolm fought for civil writes and started a program he called "Fishing For The Dead." The goal of this program was outreach to incarcerated African Americans to help them with recovery, employment, and to avoid future incarcerations (Haley, 1999).

The recovery legacies of Frederick Douglass and Malcolm X offer three lessons: 

1. Addictions professionals who work with African Americans with substance use disorders need to be trauma specialists. Like Douglass and Malcolm, many African Americans with substance use disorders have legacies of historical and current trauma that include slavery, lynchings, mass incarceration, police brutality, high unemployment, and community violence.

2. Advocacy can be a liberating force for African Americans in recovery. There is a famous 12-step slogan, "To keep it, you've got to give it away." In other words, one can maintain their own recovery by helping others. Both Malcolm X and Frederick Douglass were advocates for African Americans in their recovery. One question to ask African American clients is: “How can the African American Community benefit from your recovery (Williams, 1993)?”

3. It is important to honor multiple pathways of recovery for African Americans. Neither Douglass nor Malcolm X initiated recovery through a treatment facility. While many African American who initiate recovery  through traditional treatment, other African Americans initiate and maintain recovery through 12-step recovery, faith-based recovery, medication-assisted recovery, solo recovery, dual recovery, rites of passages, and return to culture.

 About the author Mark Sanders, LCSW, CADC is Illinois state project manager for the Great Lakes ATTC, MHTTC, and PTTC. He is founder of Online Museum of African American Addictions Treatment and Recovery. Photo Credit: Frederick Douglass,  Library of Congress, public domain

References Douglass, F. Narrative of The Life of Frederick Douglass (2019) Kindle Edition.

Douglass, F. Temperance and Anti-Slavery. Address Delivered Paisley Scotland, March 30, 1846.Renfrewshire Advertiser, April 11, 1846.

Haley, A. The Autobiography of Malcolm X. (1999) Ballantine Books. New York, NY

Payne, L & Payne, T. The Dead Are Arising: The Life of Malcolm X. (2020). Liveright Publishing Corporation. New York, NY

Williams, C. & Laird, R. No Hiding Place. (1993). Harper Collins, New York, NY

White, W. Slaying The Dragon. (2014). Lighthouse Institute. Bloomington, IL.

https://attcnetwork.org/centers/great-lakes-attc/news/lessons-recovery-legacies-frederick-douglass-and-malcolm-x

 

In Memory of Denise Eligan

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It is with sadness that I write of the death of my long term friend and colleague Denise Eligan and with gratitude that I was able to call her a friend for many years. You are fortunate if you have a colleague like Denise Eligan in your life time. Denise and I worked as young drug counselors in 1985 at Hyde Park Hospital. The unit census dropped to 2 clients and my supervisor decreased my work hours from 40 per week to 20 hours per week. At 20 hours per week I would not have been able to afford to pay rent or buy groceries. Denise told our boss that rather than my working 20 hours per week that she would split her work hours with me and we could each work 30 hours per week. Who does that!!

 I am most grateful to Denise for the impact that she had on my family. In the 1990's my brother had  an active addiction and said he wanted to write screen plays about his life experiences. I told him of my friend Denise Eligan who was a writer extraordinaire that could co-write with him. I was hoping that while they wrote together her recovery would rub off on him. It did! Denise helped him get placed in detox and he is now in long term recovery! He co-wrote movie scripts with Denise during the early phases of his recovery and often spoke of how her wisdom contributed to his recovery. My brother and sister's in law also achieved long term recovery after Denise placed them in treatment.

 Denise was an amazing drug counselor and said to me years ago People in recovery have other skills besides counseling. Her life was a living testament of this. Denise received a Masters Degree in Creative writing from Columbia College, Chicago. She wrote and directed a play, co-wrote 3 motion picture screen plays and was the editor of Recovered Magazine, one of the first recovery magazines in the nation. Denise was not only a creative writers, she was one of the nation’s best behavioral health grant writers. She was awarded a grant for an innovative program in Gary, Indiana Public Housing. The program was named Named Miracle Village and Provided addictions treatment services for women in the public housing development. Miracle Village consisted of 4 adjacent row houses, each provided specialized services for women seeking recovery (the recovery center, mental health facility, medical clinic and day care center for the client's children). Denise secured hundreds of thousands of Dollars as a Grant Writer for the State of Illinois.

 Denise's retirement from the State was Graceful. She pursued painting upon retirement and quickly developed a reputation as a great artist. It is written that most people use little of their God given talents. Along with individuals like Ben Franklin and Paul Robeson, Denise Eligan made the most of the many talents God gave her. I am blessed that she was a part of my family’s life for so many years.

How ‘Strange Fruit’ Killed Billie Holiday

by Brandon Weber February 20, 2018

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Billie Holiday and Mister at Downbeat in New York City, ca. Feb. 1947. Courtesy Library of Congress.

“Strange Fruit” may have been written by American song-writer and poet Abel Meeropol (a.k.a. Lewis Allen), but ever since Billie Holiday sang the three brief stanzas to music in 1937, she’s owned it.

Holiday, born Eleanora Fagan, said she always thought of her father when she sang “Strange Fruit.” He died at age thirty-nine after being denied medical treatment at a Texas “whites only” hospital. Because of that memory, Holiday was reluctant to perform the song, but did so anyway to tell people about the reality of life as a black man in America.

“It reminds me of how Pop died,” she wrote in her autobiography. “But I have to keep singing it, not only because people ask for it, but because twenty years after Pop died, the things that killed him are still happening in the South.”

The song was so poignant for Holiday that she laid down some rules when she sang it at her gigs: She would close the evening with the song; the waiters would stop service when she began; and the room would be in total darkness except for a spotlight on her face. There would be no encore.

“Lady Day,” as Holiday was called by many at the time, began to work the song into her repertoire sixteen years before Rosa Parks refused to give up her seat on the bus in Montgomery, Alabama. Jazz writer Leonard Feather referred to the song as “the first significant protest in words and music, the first significant cry against racism.” Click here to continue reading. Click the arrow below to watch the video.

DRUG ABUSE COUNSELORS IN HEAVEN

I received a call today from a young Addictions Counselor who told me that her mentor, Emmitt Hines died. In 1982, the year I became a drug counselor, Emmitt was my first mentor. He was a member of the Illinois Chapter of the National Black Alcoholism Council (NBAC). These seasoned pros from NBAC volunteered to do trainings to prepare the next generation of African Americans to become Certified Addictions Counselors. While many of these trainers went on to have stellar careers, Emmitt Hines was by far the best presenter. He had a charismatic style which included humor, laughter and spontaneous diagrams on the flip chart. He taught with such clarity that anyone could retain his lessons. Instantly, I wanted to be like Emmitt Hines. He was someone I knew I could learn from.

Emmitt worked at Hyde Park Hospital in the early 1980's as an Addictions Counselor and that too was impressive as most African Americans I knew worked at agencies. I asked him if I could volunteer to co-lead a therapy group with him at the hospital to continue learning from him. He said, yes. I quickly discovered that he was as effective as a group therapist as he was a presenter! His style was charismatic, I marveled at how he could make a whole group of clients laugh. He counseled with a rhythm. It is difficult to describe to new counselors today how counselors like Emmitt counseled with a Charismatic Rhythm. The old school counselors had the ability to leave an entire room spellbound. New counselors would have to see it to understand. I thought of Emmitt as an African American Sigmund Freud.

In the Mid 1980's Emmitt invited me and another newer counselor James Brumley to his office on North Michigan Avenue (The Magnificent Mile!). To be honest with you, when he put the key in the door I did not expect it to open. As far as I knew, only multimillionaire John. H. Johnson, Publisher of Ebony, Essence and Jet Magazine's had an office on N. Michigan Avenue. The key worked! Emmitt, James and I talked about partnering to open a counseling center on Michigan Avenue.

While we never opened the center, Emmitt Hines stretched my imagination. I followed in his footsteps and became a counselor at Hyde Park Hospital. I opened a private practice office on The Magnificent Mile, with views from my windows of both the Chicago River and N. Michigan Avenue. I helped train future African Americans pursuing certification as Addictions Counselors and I have done presentations all over the world trying to display the clarity and style that I learned from Emmitt.

If there is a need for Drug Abuse Counselors in the here after, Heaven just received one of the best. Rest in Peace Emmitt!