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Substance use disorder does not discriminate. While it is an issue across all demographics, it has traditionally been an issue that mostly impacts White communities. Statistics from January 2022 reflecting opioid overdose Emergency Department visits in North Carolina seem to support this narrative, as those treated were predominantly male, White/Caucasian, and ages 25-34.

However, this narrative is quickly changing. Overdose rates are increasing fastest among historically marginalized populations. Between 2019 and 2020, overdoses increased among historically marginalized groups by:

  • Hispanics: 42%
  • African Americans: 52%
  • American Indian/Alaska Natives: 75%

Because of this, North Carolina has adopted the Opioid and Substance Use Action Plan 3.0. This action plan is designed to address substance use disorder through the lens of equity and lived experiences.

The Opioid and Substance Use Action Plan 3.0 acknowledges that our public health approach to harm reduction must use a research-based, culturally competent approach to educate and engage historically marginalized audiences. While opioids receive a lot of media attention, the type of drugs that are misused and cause deaths in other racial groups often vary.

Four priority areas outlined in the State’s Action Plan include:

  1. Acknowledging and addressing systems that have harmed historically marginalized people. For example, according to the NAACP’s Criminal Justice Fact Sheet, the rates of drug use among African Americans and whites are similar, but African Americans are imprisoned on drug charges at almost 6X the rate of Whites. According to a study by a team of researchers from the UNC-Chapel Hill Gillings School of Global Public Health, the N.C. Division of Public Health, and the N.C. Department of Public Safety (DPS), individuals in North Carolina who were formerly incarcerated are 40 times more likely to die from an opioid overdose in the first two weeks following release than the general population. One year after release from prison, that number remains 10-18 times the state average.
  2. Focus on support for families and children to prevent future addiction and address trauma, working to break the cycle.
  3. Harm reduction strategies across all abused substances. Free Naloxone kits and syringe exchange services are two tools currently available.
  4. Connecting recovering addicts to care, housing, and employment so they may once again become contributing members of society.

Addressing substance use disorder is a long-term process that will require input from all communities, as well as those who are currently or have past “lived” experience using drugs. It is time we reframe the substance use disorder discussion to treat it as a medical issue and find equitable solutions for all North Carolina residents.

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