Racial disparity in addiction treatment access highlights inequities of opioid epidemic

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• Amna Nawaz:

  The CDC says synthetic opioids, particularly fentanyl, contributed to about 75,000 overdose deaths in the United States last year. It's a crisis that hits every demographic group, but there are large racial disparities between who's offered the most effective treatment and who isn't.

  William Brangham reports for our ongoing series America Addicted and Race Matters.

• Kevin Hargrove, Patient:

  I would travel from Washington, D.C., as far as to California to participate in martial arts tournaments.

• William Brangham:

  Kevin Hargrove has spent much of his life teaching and competing in martial arts. He loved the discipline and the combat, but now this 66 year-old says his main fight is with pain.

• Kevin Hargrove:

  I have broken just about every bone in my body except my spine, my skull and my pelvis. That is where I was originally introduced to Tylenol 3's Tylenol 4's, Percocets. The doctors would prescribe them for me.

• William Brangham:

  He started on prescription pain medication as a teenager. Those pills later became a habit he could not quit. By his 40s, his life was spiraling down.

• Kevin Hargrove:

  When you are going through codeine withdrawal, it is the same exact thing as going through withdrawal from a drug, say, heroin. They are opiates.

• William Brangham:

  Hargrove now has no permanent home, still struggles with opioid addiction, and often has to sleep under a bridge in Washington, D.C. Once a month, he makes a long commute to go see the man who is trying to help him get a handle on that addiction.

• Dr. Edwin Chapman, Addiction Specialist:

  How have you been?

• Kevin Hargrove:

  I'm great, great, man, thanks to you.

• William Brangham:

• Dr. Edwin Chapman:

  We are just going to get your medicine put in.

• William Brangham:

  Chapman is an addiction specialist who has been treating mostly African American patients with opioid use disorders for more than two decades.

• Dr. Edwin Chapman:

  We have lost some patients that we just couldn't stabilize.

• William Brangham:

  Chapman prescribes all of his roughly 200 patients a drug called buprenorphine. Combined with another drug, it is known as Suboxone, and it helps people withdraw from opioids, and reduces their cravings.

  It is one of three federally approved medications to treat opioid use disorders. Hargrove has been a patient of Dr. Chapman's since 2017 and now takes Suboxone, on his own, four times a day.

  What role do you see Suboxone playing in his life?

• Dr. Edwin Chapman:

  It's a lifesaver. I would dare to speculate, knowing what has already happened, I don't think Kevin would be here.

• William Brangham:

  Without it.

• Dr. Edwin Chapman:

  Without it.

• William Brangham:

  But earlier this year, Hargrove had to switch his Medicaid-funded insurance to a insurer that no longer covered that full four doses of Suboxone.

  When he was taking only three, his cravings went up, and he relapsed, buying on the street what he thought was codeine, but were counterfeit pills laced with fentanyl. He overdosed, but, thankfully, his sister found him.

• Kevin Hargrove:

  She told me my eyes went up into my head. I started slurring my words, and the next thing she knew, I was on the floor not breathing and no pulse.

• William Brangham:

  Hargrove was saved by paramedics who used the overdose reversal drug Narcan.

  You have this drug that you believe is really helping your patients, and they struggle with access, insurance, paying for it. How common is that?

• Dr. Edwin Chapman:

  It is every day. It is every day. We see about 20 patients a day. There is no standard of care, and that is what we are concerned about, the fact that everyone should have the same rules, and we should be able to dose everybody up to the maximum dose that we think they need, because it saves lives.

• William Brangham:

  Hargrove's story is unfortunately a familiar one, particularly for Black Americans.

  Across the U.S., overdose deaths among Black people are rising faster than any other ethnic group, but they are far less likely to be prescribed these medications that are proven to treat opioid addiction.

  A recent study shows that white patients receive those medications up to 80 percent more frequently than Black patients.

• Dr. Ayana Jordan, Addiction Psychiatrist:

  There still remains very considerable barriers for Black people compared to white people in accessing medication for addiction treatment for opiate use disorder.

• William Brangham:

  Dr. Ayana Jordan is an addiction psychiatrist who teaches at NYU's Grossman School of Medicine. She says Black patients are often treated differently by addiction providers.

• Dr. Ayana Jordan:

  There's still this thought that Black people who have a opiate use disorder have to be controlled in a way that white people don't, that Black people are not as trustworthy with their medications, that they won't be able to handle it, that they will sell it. And what we have seen is, that's not the case at all.

• William Brangham:

  This bias, she says, stems from several factors.

  Only 5 percent of all physicians in the U.S. are African American, and Black patients are less likely to have access to doctors who are authorized to prescribe buprenorphine. On top of that, pharmacies in Black neighborhoods often don't carry addiction medications.

• Dr. Ayana Jordan:

  So, if you're a Black person who has a substance use disorder, a opioid use disorder who also needs access to medication, you are not going to feel empowered to come out and ask for help, because you already know that people are going to treat you differently. They're going to stigmatize you.

• William Brangham:

  Studies have found that white people are 35 times more likely to receive buprenorphine than Blacks.

  The roots of this disparity date back several decades, says Helena Hansen. She's author of the book "Whiteout: How Racial Capitalism Changed the Color of Opioids in America."

  Why is it that there is such a huge racial disparity in who gets buprenorphine?

  Dr. Helena Hansen, UCLA Department of Psychiatry: The medication itself was introduced and legalized as a doctor's-office-based treatment for opioid use disorder as a response to a suburban — a quote, unquote — "suburban, perceived as white, opioid crisis in the late 1990s to early 2000s. So this was rolled out as a treatment for a very specific clientele.

• William Brangham:

  Hansen says this results in Black and brown patients often being left with only one medication treatment option, methadone, a medication that works, but comes with many more strictures.

• Dr. Helena Hansen:

  If you are on methadone treatment in this country, you're restricted to a very small handful of clinics that are directly licensed and regulated by the DEA, that require you to come in every day to be watched taking your medication to ensure that you're not diverting the medication, not swallowing it and perhaps trying to sell it on the street.

  You're going to be subject to regular urine testing. It's a much different feeling than being in a private office with a personal doctor.

• Dr. Edwin Chapman:

  And you haven't had any trouble with your diabetes or blood pressure?

• William Brangham:

  At Dr. Chapman's office in Washington, his mostly older patients have lived difficult lives. Many have been homeless or spent time in prison, but, here, they not only receive buprenorphine, but also have regular physicals and can get mental health care as well.

• Man:

  I want to see just once in my life how to live.

• William Brangham:

  Dr. Chapman says this is all particularly important in Washington, D.C., where Black people account for more than 80 percent of all opioid overdose deaths since 2017.

• Dr. Edwin Chapman:

  When we look at overdose death statistics, we see that, generally, only one out of 10 has actually been on medication-assisted treatment. So there's an obvious gap there.

• William Brangham:

  For Kevin Hargrove, he is now back on his regular four-dose regimen of Suboxone and working every day to maintain his sobriety.

• Kevin Hargrove:

  If it was not for Dr. Chapman and not for me taking the Suboxone, I would have been dead a long time ago.

• William Brangham:

  For the "PBS NewsHour," I'm William Brangham in Washington, D.C.