The city of Huntington, a community of nearly 50,000 located in western West Virginia, over the past several years has felt the harsh impact of the nation's drug abuse crisis.
The state's mortality rate from drug overdoses rose by 65% between 2009 and 2013. Huntington lies within one of the most heavily affected counties in the state, where more than 900 people overdosed in 2015. Seventy of them died.
Jim Johnson has seen firsthand how the face of drug abuse in Huntington has shifted over the years.
“I came onto the police department in 1972, and the people ... on heroin were that part of society that you were walking down the street, and you would want to go to the other side,” said Johnson, who is now director of the Mayor's Office of Drug Control Policy for Huntington. “Now there has hardly been a family that has not been affected.”
That reflects the scope of the epidemic. The rate of heroin-related overdose deaths nationwide has nearly quadrupled since 2002. An estimated 30,000 people die every year from opioid overdoses.
But unlike drug epidemics of the past, minority populations have seen a less dramatic increase in drug addiction and deaths compared to young white adults. The rate of heroin use among white adults increased by 114% between 2004 and 2013, according to the Centers for Disease Control and Prevention. The rate among nonwhite adults remained relatively unchanged during that same period.
Dr. David Rosenbloom, professor of health policy and management at Boston University's School of Public Health, thinks he knows why. “Blacks have been undertreated for pain for decades,” he said.
The stark rise in addiction can be traced back to the increased use of prescription pain relievers such as OxyContin and Vicodin. Prescriptions for opioid analgesic medications have skyrocketed since the introduction of OxyContin in the mid-1990s. In 2012, the number of prescriptions written for opioid drugs reached 259 million.
Regulators only a few years ago began implementing stricter limits on the number of pain pills doctors could prescribe, which resulted in lower prescribing rates for opioids, but also led to a subsequent rise in heroin use, a cheaper and easier alternative to prescription pain medicines.
A 2008 JAMA study found minorities were less likely to receive opioids for pain in an emergency department compared to whites.
Some say physician prejudice leads many to prescribe opioids less frequently for black and Latino patients than for whites.