By Dianne Anderson

Fentanyl, once known as a white suburban and rural youth problem stemming from “pill mills” of the southeast and midwest, has now morphed into an inner city Black men problem, where overdose deaths are rising faster than all other groups.

Early on in the epidemic, health providers generously blamed addiction in white  communities on  opioid mass production and easy access to pharmaceutical oxy. For Black people, use and death was labeled more as street level addiction and criminal, not clinical.

A familiar double standard.

Drug use in Black and Brown communities stayed relatively stable from about 2013 through 2017, mostly crack, methamphetamine and heroin, but street fentanyl has flipped the demographic script.

Now, inner cities are flooded with the drug.

Given the high risk of repeat overdoses after emergency room visits, missed referrals mean Black patients never get a real chance at treatment, or survive the next one.

A recent JAMA Network Open study of 1,683 patients showed persistent disparities. White patients were nearly twice as likely as Black patients to receive outpatient addiction treatment referrals, at 9.6% compared to 5.7%.

Looking at barriers facing those most at risk, in a recent webinar Moderator Pilar Marrero of American Community Media said LA County’s overdose crisis claims more than 2,000 lives annually, with Black, Latino, Indigenous, and low-income communities hardest hit.

One of the main ways officials are trying to keep people alive is by expanding access to Naloxone, and according to county data, deaths are beginning to decline.

Dr. Brian Hurley, an addiction psychiatrist, said overdose deaths in Los Angeles County dropped 22 percent in 2024 compared with 2023, with fentanyl and methamphetamine driving the largest declines.

“So we have a lot to celebrate, that we’re seeing a decline in deaths related to overdose, but this decline in death related to overdose is not experienced by every community here in Los Angeles County equally,” said Dr. Hurley, medical director of Substance Abuse Prevention and Control for L.A. County Public Health.

For overdoses, he said Latinos have the highest in raw numbers, but Black Los Angeles County residents continue to have the highest rate of fentanyl-related overdoses and deaths compared to white, Latino, and Asian Los Angeles County residents.

Right now, the strategy is focused on prevention, harm reduction tools such as Naloxone and test strips, treatment, recovery, and expanded outreach to youth through schools and child welfare partners.

Dr. Hurley also pointed to data showing overdose deaths among the homeless, which runs highest for men and adults 25 and older, noting that many homelessness risk factors increase overdose vulnerability.

He said the “one pill can kill” message is often used by law enforcement, but he stressed that public health must prioritize survival over stigma, and that people understand the risks of the drug supply.

“That’s part of the information we’re putting out to the community. So never use alone, always have Naloxone on hand. People make sure how they can get help. We have a youth system of care. We have a prevention network,” he said.

Shoshana Scholar, Director of the Harm Reduction Division (DHS), talked about the community model that focuses on investing in healthier neighborhoods and expanding “Health Hubs,” indoor spaces providing medical care, meals, and referrals.

Among her special initiatives, the county has installed free, “no-questions-asked” vending machines in LA County jails, allowing people to leave with Naloxone kits.

“We put vending machines in the jail and overdose prevention training videos so people can learn how to recognize and prevent an overdose and then how to respond with both rescue breathing and Naloxone. And this has resulted in 50,000 reversals,” she said.

Millions of doses have already been distributed, she said, resulting in 50,000 recorded reversals by community members since 2019.

Overseen by Shoshana Scholar’s division at DHS, other efforts include the Skid Row Care Campus, a 33,000-square-foot public square, serving an average 3,000 people daily with showers, laundry, a medical clinic, and the neighborhood’s first methadone center.

“That is really a story about all of LA becoming first responders and taking care of people who are in crisis and really extending themselves, going beyond to save lives, save their friends’ families’ lives, support their community, build stronger and safer tomorrows, make sure people are around to do that,” she said.

In South Los Angeles, Kelvin Driscoll, director of the Homeless Outreach Program Integrated Care System (HOPICS), said his team is out “in living color” saving lives while the briefing took place.

Driscoll said that HOPICS’ 38-year history and community-focused drop-in centers, noting that the team has also distributed 48,000 doses of Naloxone, resulting in 599 life-saving reversals.

While leading coordinated entry and reentry efforts, he said HOPICS prioritizes housing and homelessness services, behavioral health, mental health, and substance use and intensive case management.

He also commended his program’s more than 500 staff members, who show up daily to support South Los Angeles residents and advocate for the community.

“So when we say that our teams are delivering life saving work, it’s not just hyperbole, it’s not conjecture. Right now, while we are on this briefing, they are doing this work. And 599 people are still alive today because of the partnership with the county and because of the expertise of our teams,” he said.

For Aurora Morales, Associate Director at Homeless Health Care Los Angeles, her own personal journey and recovery from crystal meth addiction and homelessness was possible because of the judgment free care she received.

After years of struggling with addiction, Morales credits her faith in God as the foundation for her leadership at Homeless Health Care Los Angeles. She now directs the specialized overdose response teams.

“That’s kind of what triggered me going into different spaces. A lot of what I experienced was, thankfully, the people that were put in my path were people that, compassionately and non-judgmentally, were able to connect with me,” she said.

At that critical point, she said that she needed care without stigma.

“If no one’s looking for you, if no one sees you, no one’s going to know that you’re dying. Thankfully, we have these overdose responders in rotation,” she said.

She said they are now flooding the streets with Naloxone, distributing and providing training as they go, making sure community members in isolated areas have the tools they need, and the knowledge to save friends, family, and even strangers.

“We’ve gotten reports from people that say, hey, thank you for handing out that kit, it’s helped me save someone’s life at the bus stop the other day,” she said. “And this goes along to just [say], we need to continue this trajectory.”

For more Resources and Information:

HOPICS (Homeless Outreach Program Integrated Care System): South Los Angeles services   https://www.hopics.org

Homeless Health Care Los Angeles Overdose prevention, training, and specialized response teams. https://www.hhcla.org

The Skid Row Care Campus Health hub and Skid Row services,  https://dhs.lacounty.gov/housing-for-health/our-work/re-health/

L.A. County Department of Health Services  Harm Reduction Division, Naloxone distribution and jail vending machines. https://dhs.lacounty.gov/harm-reduction/

JAMA Research on racial disparities in emergency department addiction treatment referrals https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2804603

California Overdose Surveillance Dashboard on overdose rates by race and ethnicity across California. https://skylab.cdph.ca.gov/ODdashboard/

Never Use Alone toll-free national hotline, see https://neverusealone.com  or call 1-800-484-3731

SAMHSA’s National Helpline, 24/7 treatment referrals https://www.samhsa.gov/find-help/national-helpline, call 1-800-662-4357