Call for action to address unequal access to treatment as pandemic rages 

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As the COVID-19 global health pandemic continues to impact every part of our lives, overdose deaths continue to skyrocket, particularly in the Black community.

Between January 2020 and the end of June, 165 individuals in the City of St. Louis lost their lives to an overdose, representing a 36% increase from the same period in 2019. But those deaths are not impacting white and Black residents proportionally. In fact, according to preliminary data released by the Missouri Institute for Mental Health, overdose death rates for the first half of 2020 among Black residents have increased by 54% while increasing among white residents by just 11%. This despite the fact that only 33% of the regional population is Black.

St. Louis Region Race and Sex Changes in Overdose Deaths

Black males continue to bear the brunt of this tragedy. And for those paying attention, this comes as no surprise.

Hesitancy in Calling 911. Our region, our state, and our country have a long, storied history of racial segregation, health disparities, systemic racism, and generally ignoring issues that impact communities of color.  Indeed, one of the biggest barriers to seeking help for a substance use disorder is fear of arrest. According to a Pew Charitable Trust survey in 2016, white people were far more likely to have confidence in their police department (42% a lot, 39% some) than Black people (14% a lot, 41% some).  

The War on Drugs, a failed, racist, agenda has only perpetuated the problem. Far too often, white folks seeking respite from their chronic illness are channeled into treatment facilities, self-help groups, and drug courts. Black folks, on the other hand are more likely to see the inside of a jail cell or probation office. 

Lack of access to resources. The American Community Survey reveals that within the City of St. Louis, Black residents are twice as likely to be uninsured than white residents. Lack of insurance (either Medicaid or private commercial insurance) means that people are unable to access affordable treatment or harm reduction measures, like Narcan. A lack of transportation infrastructure also makes it difficult for people who want help to receive help. This is only exacerbated by a lack of brick and mortar treatment facilities north of the infamous Delmar Divide.

Distrust of existing systems. While opioid use began to appear on newspaper and television headlines between 2010 and 2015, St. Louis’s Black community had been enduring an opioid crisis for decades. Many still attest that systems only began to pay attention when white, suburban teenagers began to overdose. 

Incarceration-first policing models, prejudice against “drug addicts,” misunderstanding about medication-assisted-treatment and the rise of “white savior” mentalities have created deep rifts between the entities charged with providing assistance and those most needing that assistance. 

What now? We must insist that entities apply a racial equity lens when providing services.  We must demand innovative strategies to address community needs that elevate lived experience. Entities like NOMODEATHS ( and the MO-HOPE Project ( are attempting to do this work, but more must be done.

We must tear down barriers that prevent people from getting the help they need and further explore strategies that will save lives.  Sample strategies include sterile syringe access and expansion of addiction medicine into the primary health care setting.  Moreover, so long as individuals at high risk of witnessing or experiencing an overdose have a deep distrust of 911 responses, we must expand access to naloxone and breathing masks, at homes, in churches, and in community centers. 

We must advocate for a rapid implementation and full funding of Missouri’s Medicaid Expansion. Medicaid Expansion, as passed by Missouri voters in August 2020, will increase access to affordable treatment and medication, helping to reduce the racial disparities that exist due to socio-economic and employment factors.

We must empower African-American families with knowledge and education to be an advocate for their loved one, by providing support and attending provider appointments.

This is not an exhaustive list of ways to remedy the situation. Rather, they are next steps in a long journey to address the consequences of systemic racism in our region.  

The current surge in overdose deaths particularly among our Black residents, is a cause for serious alarm and should serve as a wake-up call to service providers, politicians and corporations. All options must be on the table to remedy this dire situation, as every data point represented is someone’s mother, father, brother, sister, cousin, or child. 

To talk to a counselor or to join the fight, contact us at

Nichole Dawsey is executive director of NCADA.

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I registered for an account to thank you for this article. Please keep drawing attention to the health disparities affecting the black community, particularly in regards to drug use. We as a harm reduction movement have not adequately met the needs of persons of color, and it’s time. Thank you.

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