This research paper focuses on prescription opioids and its effects on the African American community. The author discusses the background, best treatment intervention, and ethical considerations associated with prescription opioids and their use within the African American population.

1. RUNNING HEAD: PRESCRIPTION OPIOIDS & AFRICAN AMERICANS RESEARCH
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Prescription Opioids and African Americans Research Paper
Latagia Copeland-Tyronce [latagia.copeland@wayne.edu]
Wayne State University School of Social Work
Health Disparities & Substance Use: SW 7150
July 20, 2018

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BACKGROUND/LITERATURE REVIEW
Prescription opioids and its effects on the African American population, specifically, is
the focus of this paper. Opioids can be divided into two main categories and/or types; Opioids,
which refers to a substance that is able to bind the opioid receptors such as OxyContin®,
Percocet® and Vicodin®; and opiates, which refers to substances that are directly derived from
naturally occurring opium such as morphine and codeine. Narcotic is another term that is
commonly associated with opioids and/or opiates and tends to be reserved for law enforcement
and the public when referring to opioids that are used illicitly. Opiates are not a new drug and/or
substance by any means, and in fact, have been used by humans as far back as 3400 BC wherein
the Sumerians of Mesopotamia were the first to cultivate the opium poppy (Wilkerson, Kim,
Windsor & Mareiniss, 2015).
Over time, opium and its use, spread along routes of trade and conquest and during this
period, opium was used both to get high and as a viable and effective treatment for various
medical conditions. However, and during the Medieval Inquisition, most Europeans no longer
used opium on a regular basis. However, this changed when Philippus von Hohenheim, who is
sometimes referred to as the “father” of toxicology, reintroduced and promoted the use of
laudanum, an elixir made of opium, for medical treatment in Europe.
Another important figure in opioid history is Friedrich Sertürner who was the first to
isolate pure morphine in 1804. It was Charles R. A. Wright, in an effort to find a non-addictive
alternative to morphine, who was the first to synthesize diacetylmorphine (also known as heroin)
in 1874. However, it was the Bayer Pharmaceutical Company who later marketed
diacetylmorphine as an analgesic and cough suppressant; this [heroin] was also sold as a
medication to help people addicted to morphine (Wilkerson, Kim, Windsor & Mareiniss, 2015).

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In recent decades, [prescription] opioids in their current form are primarily used to treat
both acute and chronic pain. According to the National Health Interview Survey (NHIS) in 2012,
there are an estimated 25 million adult Americans that suffer daily from pain; with another 23
million adults who suffer from severe recurrent pain, resulting in disability, loss of work
productivity, loss of quality of life, and reduced overall health. While many healthcare
professionals agree that the multidisciplinary team approach [which includes physical and
psychological therapies, relaxation and pain coping skills training, and self-hypnosis] is a safe
and highly effective alternative to opioids when treating patients with chronic pain, many third-
party payers and/or insurance providers regard them as too expensive. Therefore, there are
currently fewer than 200,000 patients nationwide receiving multidisciplinary treatment
(Meldrum, 2016).
Instead long-term use of [prescription] opioids are the primary method of treating chronic
pain in the U.S. The misuse and/or abuse of prescription medications has been defined as the use
of prescription medications in doses that do not meet individual clinical needs, use of
prescription medications for an extended period or use of prescription medications for the
experience or feelings derived from the medication. According to the National Institute on Drug
Abuse, the abuse of drugs and addiction to opioids such as perception pain relievers, has become
a serious global problem that affects the health, social, and economic welfare of all societies.
Moreover, it is estimated that between 26.4 million and 36 million people abuse opioids
worldwide; with an estimated 2.1 million people in the United States suffering from substance
use disorders related to prescription opioid pain relievers in 2012 and an estimated 467,000
addicted to heroin (Volkow, 2014). An even more recent study concluded that more than 54
million people aged 12 and older had abused prescription drugs at some point in their lives and

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nearly 15 million people had done so in 2014. 5 More than 6.5 million people had abused
prescription drugs in the month preceding the study and would qualify as current abusers. That is
more than 2.5% of the U.S. population aged 12 and older (Center for Behavioral Health &
Statistics, 2015).
Starting in the late 80s and peaking in early 2000s, there have been several contributing
factors that have helped bring about the current prescription drug abuse problem and/or epidemic
that the U.S has been experiencing over the last decade or so. The primary factors include:
aggressive marketing by pharmaceutical companies, dramatic increases in the number of
prescriptions written and dispensed by physicians, and greater social acceptability for using
medications for different purposes such as for chronic pain. Together, these factors have helped
create what some, substance abuse and medical professionals, have deemed an, “environmental
availability” of prescription medications, specifically, opioid painkillers. So, while U.S. residents
constitute less than 5% of the world population, they consume 80% of the global opioid supply
and 99% of the global hydrocodone supply (Manchikanti, 2010). The result of this widespread
problem can be seen in the number of accidental overdose deaths from prescription opioids has
soared in the United States, more than quadrupling since 1999.
Prescription opioids are indeed a problem for African Americans, like most of the
American population, however, not nearly as much as it is for the white population. And while
the “opioid epidemic” in the United States has been in the forefront of the medical, political, and
media professions for the past decade or so many scholars and medical professionals agree that it
is a pronominally white problem and/or issue (Hansen & Netherland, 2016). There are several
reasons why the opioid epidemic, by and large, has had significantly less effect on African
Americans, such reasons include: racism and white privilege within the medical profession (eg.

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less likely to be prescription pain medication even when needed) and the high concentration of
prescription opioids within white rural populations (Castillo, 2017).
Furthermore, numerous sources and/or studies have concluded that white people use
and/or abuse opioids at higher rates than African Americans and that 82 percent of the people
who died of opioid overdose in 2015 were white. Moreover, the rate of opioid overdose deaths
per 100,000 in 2015 was 13.9 for whites, 6.6 for blacks and 4.6 for Hispanics (Castillo, 2017).
And while whites do use and abuse prescription opioids at higher rates than African Americans,
the use and abuse of prescription opioids has increased for African Americans over time.
According to the Centers for Disease Control, from 2010-2014 the percentage increase in rate of
death from opioids per 100,000 was 267% among whites, while it was 213% among blacks and
137% among Hispanics. According to the National Institute on Drug Abuse, roughly 21 to 29
percent of patients prescribed opioids for chronic pain misuse and/or abuse them (March 06,
2018).
INTERVENTION
Cognitive Behavioral Therapy, also known as CBT, is an evidence-based intervention
which has been scientifically proven to be highly effective in the treatment of several mental
health issues including substance abuse disorder. Moreover, CBT’s effectiveness in individuals
with SUD’s has long been documented (Morgenstern, Blanchard, Morgan, Labouvie & Hayaki,
2001). That said, African Americans with substance use disorders present unique challenges due
to the oppressive racial and economic [marginalization] dynamic within our society which is
another reason why I believe that CBT is the best intervention and/or option available. And
unlike some common substance abuse interventions, CBT is highly adaptable and/or
customizable and able to be implemented with individuals with co-occurring mental health issues

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and/or polysubstance use. Moreover, CBT is not substance/drug specific meaning that the
intervention can be implemented with almost all kinds of addictive substances not just
[prescription] opioids.
Having spent almost two years working with individuals with SUDs and co-occurring
disorders, a large percentage of those individuals being of African American decent, I have
personally witnessed the success of CBT in treating these conditions. That said, preliminary
research suggests that African Americans have poorer outcomes than whites with traditional
CBT which focuses entirely upon the individual and typically does not address the effect of
prejudice and discrimination on individuals, families, and communities (Voss Horrell, 2008).
Therefore, African Americans would benefit more from CBT if it is culturally
competent/sensitive; and it is with this fact in mind that a form of CBT that is specially adapted
for African Americans is being used by several mental health and/or substance abuse
professionals.
And although there have been relatively few studies that have been devoted to
researching the effectiveness of ACBT when working with African Americans, the few studies
that have been conducted have concluded that culturally adapted forms of CBT (also known as
ACBT) are more effective than non-adapted forms of CBT. And in fact, one study found that
participants in the ACBT group had lower dropout rates and greater improvement in symptoms
and functioning than participants in the non-adapted CBT group. Another study found that the
ACBT group produced a greater decrease in depressive symptoms when compared to
demographically-matched African American women receiving non-adapted CBT in the same
clinic. These finding positively indicates that ACBT worked twice as well as the traditional

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and/or non-adapted version of CBT in treating substance abuse disorder and other mental health
issues in African Americans (Windsor, Jemal & Alessi, 2015).
ETHICAL ISSUES
There are three main, and in my opinion most pertinent, ethical issues associated with
African American prescription opioid use and/or abuse that I will be concentrating on in this
section of the paper. First, there is the ethical issue because of the “war on drugs.” And while the
war on drugs is not a new phenomenon in this country having been implemented in the early
1970s by the Nixon administration, it has had a particularly negative/devastating and
disproportionate effect on African Americans. Research has long concluded that whites and
blacks roughly use drugs (in general) at the same rates; yet black Americans are 13 times more
likely to be arrested for buying, selling, and using drugs than are their white counterparts.
Moreover, it was determined that in 2013 African Americans and Hispanics together
constituted 29 percent of the American population, but that they made up 75 percent of prisoners
in state and federal prisons for drug offenses. In 2012, the US Sentencing Commission stated that
African Americans are given longer prison sentences for drug-related offenses than white
Americans who are convicted for the same crimes (Race and Addiction, 2018). These statistics
include [prescription and illicit] opioids. There is also a difference in perception when it comes
to substance use and/or abuse in this country with white addicts tending to be viewed as victims
who need help while black addicts are viewed as pathological criminals unworthy of
compassion. Obviously, this narrative needs to change.
Second, there is the ethical issue of a growing and rampant undertreatment of pain in
African American patients also known as the “pain gap.” According to a 2016 study by the

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University of Virginia, many medical students and residents are racially biased in their pain
assessment. The study further concluded that medical student’s attitudes about race and pain
correlate with falsely-held beliefs about supposed biological differences, such as black people
having thicker skin, or less sensitive nerve endings than white people.
It is the above false attitudes and/or biases that have vastly contributed to the
overtreatment of millions of [white] people that feeds painkiller abuse at the same time and to the
systematic undertreatment of pain for millions of others [mostly black and other minorities]
(Wailoo, 2016). Simply put, African Americans, especially lower income, are much less likely to
be prescribed [adequate] pain medication and as an African American (with a professional
medical background), with legitimate and variable chronic pain, I personally attest to this fact. It
is strikingly clear that white privilege also plays in important part in both the opioid epidemic
and the African American pain gap.
And finally, there is the ethical issue of the child welfare system and the differences in
case outcomes between white and black families dealing with substance use and/or abuse.
According to the U.S. Government Accountability Office (GAO), African Americans make up
34 percent of the foster-care population, but only 15 percent of the general child population and
are more than twice as likely to enter foster care compared with white children in 2004; this was
the case even under the same familial circumstances and/or situations as their white counterparts
who were offered in home services. (GAO, 2007). Moreover, it is apparent to most child welfare
professionals that racial disparities are evident at every critical decision point within the child
welfare system and that these deep disparities in almost every state in the country (Annie E.
Casey Foundation, 2006).

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The above highlights the unique and challenging circumstances that African Americans
face. This research paper has clearly demonstrated the fact that African Americans have been
and continued to be marginalized and stigmatized in our society, this is especially the case when
substance use and/or abuse is thrown into the equation. Therefore, social workers and other
healthcare and human service professionals, need always to both be mindful of these very real
issues and consciously work to address them so that they can better serve the African American
population.

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