Opioids: How Racial and Ethnic Disparities Shape Health Outcomes and Policy

• In Event: Deaths of Despair? Framing the Opioid Epidemic

Abstract

Opioids killed more than 42,000 Americans in 2016, roughly two-thirds of all drug-overdose deaths. Yet, opioids do not affect all people in the national equally. White (17.5) and Native Americans (13.9) have higher overdose death rates than Hispanic (6.1) and Black Americans (10.3).

Race, ethnicity, immigrant, and socioeconomic status have long been associated with health disparities: with white, wealthy Americans having some of the best health outcomes and Black, Hispanic, and Native Americans having some of the worst. With opioid overdose deaths, however, the lines are murkier. With high death rates, whites are at the center of public attention. Critics claim the public health and public policy responses--treating opioid misuse as a disease rather than a criminal justice issue--has more to do with the group it seemingly affects than the nature of the problem.

Drawing on more than a 100 in-depth interviews with people on the front lines in New York State's rural Sullivan County and suburban Orange County, we seek to understand the complex relationship between race, ethnicity, immigration status, and opioids. We use variation between types of counties—rural, suburban, urban—as well as racial/ethnic variation of communities within counties—to ask: (1) what is the relationship between race, ethnicity, immigration, and opioid overdose deaths? And (2) how do race, ethnicity, and immigration shape the public health and public policy responses?

Our research has theoretical implications for research on inequality as well as policy implications, providing on-the-ground analysis of the problems local communities face. The current opioid epidemic captures, in a single instance, decades of unequal treatment (and in some cases outright mistreatment and abuse). Understanding how long-term inequalities are sewn into health outcomes and what it means to adequately address them has much broader implications for how we think about and address inequality in the United States.

This paper is appropriate for panels on health politics and policy, race and politics, or framing and inequality.

Authors

• Elizabeth Perez Chiques, Centro de Investigación y Docencia Económicas

• Patricia Strach, University at Albany, SUNY

• Katie Zuber, Rockefeller Institute of Government