Former Tampa Bay Buccaneer Keith McCants was to be the keynote speaker at a September meeting to address a subject he knew too well, the rise in opioid use among Black people.
Then he died on Sept. 2 in St. Petersburg of a suspected overdose.
McCants, 53, was trying to rebuild a life crushed by addiction to painkillers. He was selected fourth overall in the 1990 NFL draft, but his career spiraled into dozens of surgeries. Later, a brief law enforcement career gave way to legal trouble and homelessness.
Just before his death, it seemed like McCants was enjoying himself for the first time in 10 years, said friend and St. Petersburg mayoral candidate Robert Blackmon: “He paid the ultimate price for drugs.”
Many in Tampa Bay have, too. In eight counties, the number of Black people who died of drug-related causes increased from 65 deaths in 2018 to 113 in 2019, according to the most recent Florida Department of Health data available. That’s nearly double in a single year.
From 2011-21, the number of nationwide overdose deaths for Black people increased more than 140 percent, according to Ayana Jordan, an assistant professor at Yale University who studies health equity and addiction disparities. For Hispanic people, deaths rose by nearly 120 percent.
Health experts and researchers fear deaths will climb for years to come given the recent staggering increases.
The epidemic’s victims were primarily white people succumbing to opioids in the early 2010s. Now, Black and Hispanic people are succumbing at unprecedented rates.
“The rate of Black death has skyrocketed,” Jordan said. Overdose rates are increasing fastest within the Black community and, in some parts of the country, the data shows rates for Black people exceed that of white people.
Often, it’s a mix of drugs that overwhelm one’s body, experts say, making overdoses an expansive issue that encompasses more than just opioids.
How overdoses evolved
The phase of the opioid epidemic that devastated predominantly rural, white communities was driven in large part by prescription painkillers.
Prejudice shielded people of color from that first phase. Doctors tend to dismiss the pain of Black and Hispanic patients and fail to prescribe them adequate medication, said Khary Rigg, an associate professor in the Department of Mental Health Law and Policy at the University of South Florida who studies substance use.
A 2019 study showed that Black and Hispanic emergency room patients were up to 40 percent less likely to receive pain medication. Researchers say that’s because some doctors harbor biased perceptions that Black people are more likely to become addicted to and sell drugs and false assumptions that they have a higher pain tolerance.
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That is partly why 70 percent of the record 93,000 people who died of overdoses in the U.S. last year were white.
But experts say heroin and fentanyl — an extremely potent synthetic opioid — are changing who falls victim to opioid addiction. During the coronavirus pandemic, supply chains were interrupted and authentic drugs were replaced with deadlier synthetics.
“Fentanyl is a game changer,” said Jordan, the Yale researcher. For Black and Hispanic people, the presence of fentanyl in other substances, such as cocaine, drives the rising death toll. Users often aren’t aware it’s been mixed in with other drugs. That combination can be lethal, experts say.
“Prior to fentanyl coming into the supply,” she said, “we were seeing rates of opioid overdose deaths that were increasing but nowhere near the rates where we are now.”
The pandemic itself contributed to the drug crisis by elevating stress levels, another factor in the latest spikes.
Multiple stressors piled on top of each other as COVID-19 spread, triggering substance use nationwide, said University of South Florida assistant professor Micah Johnson, who teaches about substance misuse, psychological trauma and social inequality. Some of those triggers were specific to being Black, he said, like the racial reckoning that followed the murder of George Floyd and the coronavirus’ disproportionate impact in communities of color.
Additionally, COVID-19 put “a strain on institutions that promote health,” said Johnson. The pandemic cut people off from churches, cultural centers, and family events that bring joy and a feeling of connection that may protect against addiction.
“It has not been the same for nearly two years now,” Johnson said.
More than one in 10 American adults has reported starting or increasing substance use since the pandemic began, according to the Kaiser Family Foundation. It’s a spike researchers predicted when people were first told to isolate at the start of the pandemic.
‘The de facto substance use treatment center’
Barriers in access to mental health care are also contributing to rising overdoses, experts say. That is especially true for people of color who face the criminal justice system as a means to mental health treatment.
“The criminal justice system becomes the de facto substance use treatment center,” said Johnson. It’s often the first place where adults and adolescents are screened and treated for substance use disorders. And the system often fails to identify and adequately treat mental health issues, particularly for people of color.
Because of high amounts of trauma, adolescents in the juvenile justice system are more susceptible to overdose later in life. “If we can target kids there,” Johnson said, “we can prevent their substance misuse from exacerbating into adulthood.”
There’s also a gender gap in treating substance abuse. Some studies show women are less likely to receive adequate treatment.
“Adverse consequences of substance misuse can be more harsh for girls,” Johnson said.
The criminal justice system can be insensitive to the stressors women face, he said, such as the social pressures for women to be primary caretakers. In other contexts, boys may face greater risk for substance abuse due to stigma around seeking help and showing emotions.
Many Black people aren’t getting the professional treatment they need in time, said LaDonna Butler, a licensed mental health counselor in St. Petersburg.
“We still aren’t seeing Black folks’ addiction as a health crisis,” she said.
Addressing the stark disparities will take work, experts say. It requires removing barriers to quality health care and changing the narrative around the epidemic. It can’t be viewed as an issue solely affecting white communities.
“When people think of the opioid epidemic, a white face still comes to their mind,” said Rigg, the USF professor.
That’s why the staggering rise in overdoses within communities of color has gone unaddressed, he said.
Interventions initially adapted to address prescription addictions have yet to adjust to meet the needs of people addicted to street drugs, Rigg said. The war on drugs, which over-incarcerated Black and Hispanic people, left those communities distrustful of law enforcement efforts to divert people to treatment.
“It’s kind of unreasonable to think that these historically over-policed neighborhoods, that are largely Black, would suddenly view police as sources of help and support,” Rigg said.
Black folks are less likely to call for help when someone is overdosing for fear of arrest, Rigg said. “Everyone is afraid.”
And while Narcan, a nasal spray used to reverse an opioid overdose in an emergency, is highly effective, Black people lack access to that medication, he said.
Experts are optimistic about fentanyl test strips, a low-cost way to help users detect it in their drugs. Studies show it reduces the likelihood they will use those drugs and thus reduces overdoses.
Increased research and funding in communities of color would have a tremendous impact, researchers say.
Last month, U.S. Rep. Charlie Crist, who is running for Florida governor, announced two grants totaling over $1 million for opioid recovery in Pinellas County.
The funds were allocated to local service providers to improve the availability of Narcan for emergency responders and substance abuse treatment programs, which could potentially prevent deaths like McCants.
The Foundation for a Healthy St. Petersburg provides partial funding for Times stories on equity. It does not select story topics and is not involved in the reporting or editing.