Since awareness of the issue of opioid addiction began to reach public consciousness in the late 1990s, opioid addiction has been seen as a largely rural problem affecting whites of lower socio-economic status (SES). Increasingly, this is no longer the case. A study published last Friday in the Journal of the American Medical Association has found that the crisis is spreading to urban centers on the Eastern Seaboard. Furthermore, it is increasingly affecting the African-American population.

One grim statistic from the study showed that opioid-related deaths in the Washington D.C. metro region – where almost 50 percent of the population is African-American – have been increasing at an annual rate of 200 percent over the past six years. According to lead author Michael Kiang of the Stanford University Medical School, this is due largely to heroin laced with the artificial opioid fentanyl.

The other part of the equation is potency. In western states and metropolitan regions, most addicts get what is known as “black tar heroin,” a form of the drug that has the appearance and consistency of roofing tar (hence the name). This form of heroin is relatively weak compared to the white powder heroin widely available in cities such as Washington D.C., New York, and Boston. Furthermore, eastern drug dealers have taken to mixing white heroin with fentanyl, which has a virtually identical appearance. Fentanyl-laced heroin can be up to 50 times more potent than heroin alone – and increasingly, it is becoming the drug of choice among urban addicts.

Fentanyl is also being added to other street drugs such as cocaine, Kiang says.

Kiang was also the lead author on a study that appeared last September in the journal Epidemiology. At that time, he and his co-researchers pointed out that prescription opioid addiction had been driven largely by “aggressive marketing techniques by the pharmaceutical industry and changing medical standards in diagnosis and treatment of chronic pain.” That study found that African-Americans were less likely to suffer from opioid addiction because of “much lower opioid prescription rates in the black population than in the white population.” That has changed, however, as figures on heroin use have caught up to those of prescription opioids.

Kiang and his colleagues report that between 1999 and 2016, opioid abuse has claimed over 350,000 lives. Two-thirds of those fatalities were men under the age of 40.

There has been a silver lining to this dark cloud – one that, unfortunately, is in danger of being undermined as GOP lawmakers and the present Administration continue to threaten federal health care programs and chip away at the Affordable Care Act. According to a report from the Urban Institute,states that embraced the Medicaid expansion provisions of the ACA have seen the greatest improvements in access to opioid addiction treatment.

K.J. McElrath is a former history and social studies teacher who has long maintained a keen interest in legal and social issues. In addition to writing for The Ring of Fire, he is the author of two published novels: Tamanous Cooley, a darkly comic environmental twist on Dante's Inferno, and The Missionary's Wife, a story of the conflict between human nature and fundamentalist religious dogma. When not engaged in journalistic or literary pursuits, K.J. works as an entertainer and film composer.