Thomas Gooch has dedicated more than 30 years to fighting illegal drugs. A native of Nashville, Tennessee, he grew up in extreme poverty. He first went to prison in 1988 and spent the next 15 years between prison and the street because of his drug use and sales.
«I never went to treatment until 2003, and that was the last time I used drugs» — Gooch says.
Since then, for 19 years, he has been active in helping others on their journey to recovery or trying to keep them alive. He has distributed sterile needles and injection equipment to reduce injuries, infections and overdose deaths in Nashville's most vulnerable communities. In 2014, he founded My Father's House, a rehabilitation center for fathers suffering from substance abuse addiction.
Despite his extensive experience, the recent opioid epidemic has hit black communities hard, striking Gooch with its magnitude.
«I've never seen as many deaths as I do now when it comes to opioid addiction. So many funerals, I can't even believe it. In the last 10 years, I've personally known at least 50-60 people who have passed away from overdose» — he says. That shocking number includes his ex-wife, who died in 2020, and his partner, who passed away in 2019.
«I never went to treatment until 2003, and that was the last time I used drugs» — Gooch says.
Since then, for 19 years, he has been active in helping others on their journey to recovery or trying to keep them alive. He has distributed sterile needles and injection equipment to reduce injuries, infections and overdose deaths in Nashville's most vulnerable communities. In 2014, he founded My Father's House, a rehabilitation center for fathers suffering from substance abuse addiction.
Despite his extensive experience, the recent opioid epidemic has hit black communities hard, striking Gooch with its magnitude.
«I've never seen as many deaths as I do now when it comes to opioid addiction. So many funerals, I can't even believe it. In the last 10 years, I've personally known at least 50-60 people who have passed away from overdose» — he says. That shocking number includes his ex-wife, who died in 2020, and his partner, who passed away in 2019.
Since the 1990s, nearly one million people have died from opioid overdoses in the United States. Over the past decade, however, the face and ethnic composition of the epidemic has changed. Whereas before the victims were mostly white and middle-class, black and swarthy people now face long-term addiction and lack of resources.
Over the past 10 years, opioid and stimulant deaths among black Americans have increased by 575%. In 2019, the rate of drug overdose deaths among blacks surpassed that of whites for the first time: 36.8 per 100,000 versus 31.6.
In addition, due to the proliferation of fentanyl, a synthetic opioid that is 50 to 100 times more potent than morphine, black men over 55 who have long struggled with heroin addiction are four times more likely to die than other races in the same age group.
These dramatic changes can be attributed to racial disparities. Studies show that blacks have a harder time getting into treatment programs than whites and are less likely to be prescribed effective drug therapy medications.
Over the past 10 years, opioid and stimulant deaths among black Americans have increased by 575%. In 2019, the rate of drug overdose deaths among blacks surpassed that of whites for the first time: 36.8 per 100,000 versus 31.6.
In addition, due to the proliferation of fentanyl, a synthetic opioid that is 50 to 100 times more potent than morphine, black men over 55 who have long struggled with heroin addiction are four times more likely to die than other races in the same age group.
These dramatic changes can be attributed to racial disparities. Studies show that blacks have a harder time getting into treatment programs than whites and are less likely to be prescribed effective drug therapy medications.
«If you're black and have an opioid addiction, you're likely to start treatment five years later than a white person. Treatment significantly reduces the risk of overdose deaths and can be a life-and-death deciding factor. Five years can be critical» — notes Nora D. Volkow, director of the National Institute on Drug Abuse at NIH.
Black people facing substance abuse problems often fear entering the criminal justice system and are less likely to have access to quality health insurance, making it difficult to seek help. The COVID-19 pandemic has also negatively impacted many rehabilitation and harm reduction services, especially for people of color communities.
Gooch also points out that there is overt racial discrimination in health care.
«When we call various facilities trying to refer people for treatment, they are often plagued by the question, 'What drug are they using?' If you say 'crack,' all of a sudden there are no hospitalizations here. And if you mention 'opioids' and heroin, they'll find a bed because that's the demographic they're interested in. I've told patients more than once that the only way to get help is to get drunk and go to Vanderbilt Hospital because they keep patients there for five days, which gives them a chance to start treatment» — he recalls with annoyance.
Black people facing substance abuse problems often fear entering the criminal justice system and are less likely to have access to quality health insurance, making it difficult to seek help. The COVID-19 pandemic has also negatively impacted many rehabilitation and harm reduction services, especially for people of color communities.
Gooch also points out that there is overt racial discrimination in health care.
«When we call various facilities trying to refer people for treatment, they are often plagued by the question, 'What drug are they using?' If you say 'crack,' all of a sudden there are no hospitalizations here. And if you mention 'opioids' and heroin, they'll find a bed because that's the demographic they're interested in. I've told patients more than once that the only way to get help is to get drunk and go to Vanderbilt Hospital because they keep patients there for five days, which gives them a chance to start treatment» — he recalls with annoyance.
Gooch and other activists are working to improve access to drug treatment and change the current dysfunctional system. Some groups are introducing more effective drug treatment programs inside prisons, which reduces the likelihood of recidivism after release.
The proposed federal law would make it easier for all segments of the population to access methadone, a commonly used drug therapy, and reduce stigma. In turn, Volkow is using his position at NIH to bring attention to evidence-based methods for understanding and treating addiction.
Black people's access to treatment
The historical continuity of inappropriate attention to substance abuse as a public health problem rather than a criminal law problem has resulted in a health care system where only 10% of people of any race receive care for substance use disorders. Factors such as stigma and difficulty accessing treatment exacerbate the situation among racial minorities.
The proposed federal law would make it easier for all segments of the population to access methadone, a commonly used drug therapy, and reduce stigma. In turn, Volkow is using his position at NIH to bring attention to evidence-based methods for understanding and treating addiction.
Black people's access to treatment
The historical continuity of inappropriate attention to substance abuse as a public health problem rather than a criminal law problem has resulted in a health care system where only 10% of people of any race receive care for substance use disorders. Factors such as stigma and difficulty accessing treatment exacerbate the situation among racial minorities.
According to the federal government, even after non-fatal overdoses, black patients are half as likely to be referred to treatment as non-Hispanic white patients.
With the increasing realization that criminalization and prison measures do not deter illicit drug use or improve public health, there is a need for harm reduction policies. These include Good Samaritan laws, which provide limited immunity for minor drug offenses and facilitate access to naloxone, a drug that can prevent overdose.
However, racial disparities in the implementation and effectiveness of these measures do remain. A study conducted by RTI International found that black and Latino injection drug users have limited access to needed medications.
Loftin Wilson, program manager at the Harm Reduction Coalition in Durham, North Carolina, notes that problems of inequality breed distrust of the system, leading to a vicious cycle in which people who need help find it more difficult to access agencies that can provide support. People in treatment have a legitimate fear that engaging with social services could result in the loss of jobs, housing or child custody.
With the increasing realization that criminalization and prison measures do not deter illicit drug use or improve public health, there is a need for harm reduction policies. These include Good Samaritan laws, which provide limited immunity for minor drug offenses and facilitate access to naloxone, a drug that can prevent overdose.
However, racial disparities in the implementation and effectiveness of these measures do remain. A study conducted by RTI International found that black and Latino injection drug users have limited access to needed medications.
Loftin Wilson, program manager at the Harm Reduction Coalition in Durham, North Carolina, notes that problems of inequality breed distrust of the system, leading to a vicious cycle in which people who need help find it more difficult to access agencies that can provide support. People in treatment have a legitimate fear that engaging with social services could result in the loss of jobs, housing or child custody.
«This is another example of the negative experiences people who use drugs face. Its impact is not the same for everyone, and for blacks seeking treatment, it's a very different experience compared to whites» — Wilson commented.
University of Cincinnati psychologist Kathleen Burlew emphasizes that black patients tend to start receiving treatment later than whites and are less likely to complete it. The mistrust, she points out, is closely linked to physician bias and the lack of racial and ethnic diversity among health care providers.
Federal resources, such as grants to support community clinics and opioid use disorder treatment programs, are often predominantly white.
In 2021, 77% of clients treated using grant funding were white, compared to 12.9% who were black and 2.8% who were Native American. In some states, this disparity is even more pronounced. For example, in 2019, North Carolina reported that whites made up 88% of all recipients of a $54 million federal grant, while blacks accounted for only 7.5%. Native Americans represent less than 1% of those served.
University of Cincinnati psychologist Kathleen Burlew emphasizes that black patients tend to start receiving treatment later than whites and are less likely to complete it. The mistrust, she points out, is closely linked to physician bias and the lack of racial and ethnic diversity among health care providers.
Federal resources, such as grants to support community clinics and opioid use disorder treatment programs, are often predominantly white.
In 2021, 77% of clients treated using grant funding were white, compared to 12.9% who were black and 2.8% who were Native American. In some states, this disparity is even more pronounced. For example, in 2019, North Carolina reported that whites made up 88% of all recipients of a $54 million federal grant, while blacks accounted for only 7.5%. Native Americans represent less than 1% of those served.
Inequality of access to medicines
Research has revealed a bias among providers toward medication-assisted therapy (MAT), which includes FDA-approved medications along with counseling and behavioral therapy.
Addiction experts consider this approach to be the most effective in combating the problem of opioid abuse. However, a study published in JAMA Network found that about 40% of the 368 U.S. drug treatment programs studied do not offer MTL, and 21% actively discourage its use.
Many programs are based on the belief that addiction is a moral problem, and the use of medication to achieve sobriety is perceived as replacing one addiction with another. This misconception is common among general practitioners who do not specialize in addiction treatment.
Among the FDA-approved medications, buprenorphine, methadone, and naltrexone are prominent. Buprenorphine and methadone are synthetic opioids that block opioid receptors in the brain, helping to reduce cravings and withdrawal symptoms.
Research has revealed a bias among providers toward medication-assisted therapy (MAT), which includes FDA-approved medications along with counseling and behavioral therapy.
Addiction experts consider this approach to be the most effective in combating the problem of opioid abuse. However, a study published in JAMA Network found that about 40% of the 368 U.S. drug treatment programs studied do not offer MTL, and 21% actively discourage its use.
Many programs are based on the belief that addiction is a moral problem, and the use of medication to achieve sobriety is perceived as replacing one addiction with another. This misconception is common among general practitioners who do not specialize in addiction treatment.
Among the FDA-approved medications, buprenorphine, methadone, and naltrexone are prominent. Buprenorphine and methadone are synthetic opioids that block opioid receptors in the brain, helping to reduce cravings and withdrawal symptoms.
Naltrexone is an injectable medication that is used after detoxification and blocks the effects of opioids. A minority of insurance companies in the U.S. cover all three drugs, and according to the Centers for Disease Control and Prevention, the availability of the medication is much lower for black citizens.
Studies show that economic factors and race have a significant impact on the availability of certain drugs. For example, buprenorphine is more likely to be found in predominantly white counties, while clinics offering methadone are located in poor racial minorities.
Methadone requires patients to attend a clinic daily to receive and administer the drug under the supervision of medical staff. This requirement makes it difficult to perform daily activities such as studying or maintaining a job. There is also the stigma associated with waiting in a public queue, which is perceived by passers-by as a queue for drug treatment.
«The treatment system was designed based on racial bias and a stigmatizing view of people with addiction, without regard for privacy and dignity, and without recognizing addiction as a health problem» — notes Andrew Kolodny, medical director of the Opioid Policy Research Center at Brandeis University.
The situation is exacerbated by the fact that methadone is classified as a Schedule II controlled substance, which is associated with a high risk of abuse and the potential for physical or psychological dependence. This classification gives the drug a quasi-criminal status and gives clinics a reputation as minority-affiliated places.
At the same time, buprenorphine's story is quite different. After a dramatic increase in opioid use problems in white communities, Congress took action to create less stigmatizing treatments.
The Drug Abuse Treatment Act of 2000 (DATA 2000) lifted an 86-year ban on the use of narcotic drugs such as buprenorphine, which is now available under the brand names Subutex and Suboxone.
Most physicians specially licensed to prescribe it work only with private insurance and cash, making buprenorphine more accessible to affluent, mostly white patients. In a 2015 national study, about 95% of patients taking buprenorphine were white, of which 34% had private health insurance.
At the same time, buprenorphine's story is quite different. After a dramatic increase in opioid use problems in white communities, Congress took action to create less stigmatizing treatments.
The Drug Abuse Treatment Act of 2000 (DATA 2000) lifted an 86-year ban on the use of narcotic drugs such as buprenorphine, which is now available under the brand names Subutex and Suboxone.
Most physicians specially licensed to prescribe it work only with private insurance and cash, making buprenorphine more accessible to affluent, mostly white patients. In a 2015 national study, about 95% of patients taking buprenorphine were white, of which 34% had private health insurance.
https://health.usnews.com/doctors/john-woodyearjr-556732
John Woodyear, an addiction specialist in Troy, North Carolina, sees a significant increase in overdose death rates among blacks and Native Americans — up 66% and 93%, respectively, from 2019 to 2020. Its clientele is predominantly white — 90% — despite blacks making up 31% of the city's population. New patients continue to come through referrals from friends.
https://www.medstarfamilychoicedc.com/enrollees/dc-healthcare-alliance/provider/edwin-c-chapman
The Edwin Chapman Clinic in a poor and predominantly black neighborhood in Washington, D.C., provides treatment for opioid addiction, and most of his patients are black. Chapman faces restrictions from insurers that require prior approval to prescribe buprenorphine and don't take into account that black patients may need higher doses. He notes that many doctors are reluctant to take such patients for fear of coping with their economic and mental health problems.
Wilson emphasizes the cultural bias against the use of buprenorphine, where people see it as merely a substitute for one drug for another. Gooch agrees that distrust of systems of care encompasses the African American community, where there is a belief that drug addiction is a moral issue.
John Woodyear, an addiction specialist in Troy, North Carolina, sees a significant increase in overdose death rates among blacks and Native Americans — up 66% and 93%, respectively, from 2019 to 2020. Its clientele is predominantly white — 90% — despite blacks making up 31% of the city's population. New patients continue to come through referrals from friends.
https://www.medstarfamilychoicedc.com/enrollees/dc-healthcare-alliance/provider/edwin-c-chapman
The Edwin Chapman Clinic in a poor and predominantly black neighborhood in Washington, D.C., provides treatment for opioid addiction, and most of his patients are black. Chapman faces restrictions from insurers that require prior approval to prescribe buprenorphine and don't take into account that black patients may need higher doses. He notes that many doctors are reluctant to take such patients for fear of coping with their economic and mental health problems.
Wilson emphasizes the cultural bias against the use of buprenorphine, where people see it as merely a substitute for one drug for another. Gooch agrees that distrust of systems of care encompasses the African American community, where there is a belief that drug addiction is a moral issue.
According to Volkow, a new approach to drug addiction that takes biases into account is needed. Prisons can be places for change, as many prisoners have substance use disorders. However, only 1 in 13 gets the help they need. Some local programs, such as the RIvER clinic in Pittsburgh, aim to reduce recidivism by providing help after release.
New York has developed overdose prevention centers that have prevented nearly 200 cases. California implemented a law to inform patients about treatment, and federal authorities suspended strict rules allowing telemedicine counseling for receiving methadone. These steps could lead to more equitable and evidence-based drug treatment policies.