“Compounding” pandemics: Among Black and Latino New Haveners, fatal overdoses skyrocket during COVID-19

UP CLOSE |“Compounding” pandemics

Among Black and Latino New Haveners, fatal overdoses skyrocket during COVID-19

Published on April 27, 2023

New Haven resident Richard Youins has been clean since 2010. 

After battling drug addiction for over two decades, he now serves as a peer mentor for others struggling with substance use disorder, often working directly with his neighbors and friends of friends as they navigate recovery. Because of the nature of his work and his personal experiences, he is no stranger to the horrors that substance use disorder can wreak on the lives of individuals and families, especially in communities of color like his own. 

At the same time, the drugs on the street today are different than they were when he battled addiction decades ago. More people are dying of overdoses, too.

“I find myself wondering when this shit is gonna end,” Youins said. “I don’t even do funerals no more, because I’ve been to so many.”

During the COVID-19 pandemic, people across the country grappled with reduced access to in-person health care, deteriorating mental and physical health and deepening racial inequities across society. With the rise of the deadly synthetic opioid fentanyl, overdoses skyrocketed across the board. But for Black and Latino people both in New Haven and throughout the country, the rise in deaths was even steeper.

Two months ago, Youins lost a longtime friend to a fatal drug overdose. He told the News that as a Black man in recovery, he carries the harsh realities of the rising overdoses in his community with him every day, often worrying whether a given conversation with a friend will be their last.

As a peer recovery mentor, he said he is also acutely aware of the social and structural barriers to treatment that have prevented people of color from getting the help they need, both historically and in the present. He feels exhausted as social services and programs in the community, often run by white people, fail to connect with people like his neighbors and family members. These inequities have exacerbated the racial disparities in overdoses, making the risk of dying even higher for Black and Latino people who have long been overlooked in conversations about the opioid crisis.

“It’s funny that the pandemic brought this to the forefront,” Youins said. “It’s been happening all along. It’s just that all of a sudden now, the white media and the white community are recognizing it.”

Deadlier drugs, rising overdoses and escalating disparities

In 2013, a potent new street drug hit the illicit substance trade, eventually flooding the national market. Fentanyl, a synthetic opioid primarily used to treat cancer patients, was easy to illegally manufacture and sold for a cheap price. It was also about 50 times more powerful than heroin, making it more profitable to drug traffickers.

Since fentanyl and its analogs are highly addictive, manufacturers often “lace’” its active ingredients into counterfeit opioids and substances like cocaine to boost buyers’ dependency.

“Prior to 2013, if law enforcement took samples of drugs off the street and they tested cocaine or crack or heroin, which was the primary opioid back then, they would find cocaine or crack or heroin,” said state drug intelligence officer Bobby Lawlor. “When we test a sample of opioids on the street today, what we see is that there’s fentanyl in there; there are fentanyl analogs in there; there’s Tramadol in there; And a lot of times, there’s also xylazine, which is an animal sedative, in there.”

Even tiny amounts of fentanyl added to powders, injectables and pills cost lives. The Drug Enforcement Agency estimates that three milligrams of fentanyl can potentially kill an average-sized adult male. Datahaven researcher Kelly Davila told the News that in 2012, “close to zero percent” of overdose deaths in New Haven and surrounding communities involved fentanyl. Eight years later, the drug was involved in about 84 percent of regional overdose deaths

According to a 2021 Datahaven study led by Davila, most overdose survivors in the region seemed to be unaware that fentanyl likely played a role in their overdoses. Only 6 percent of survivors surveyed stated they knew they had consumed the drug. New Haven resident Isabelle Firine, whose brother Cameron had long battled addiction before dying due to an overdose, told the News that her brother purchased what he believed were oxycontin pills in 2019. The one he took was pure fentanyl.

“He was dead before he even hit the ground,” Firine said.

Like other urban areas across the country, New Haven has grappled with far higher overdose rates compared to that of the nation as a whole. A March 2023 report produced by DataHaven, which collects statistics to report on regional wellbeing and equity, estimated the Elm City’s 2020-2021 overdose fatality rate to be 445 deaths per one million residents — over double that of the state of Connecticut and 67 percent greater than that of the country.

At the start of 2012, according to Datahaven’s 2023 Community Wellbeing Index, the rates of drug overdose deaths among Greater New Haven’s Black, Latino and white populations were nearly the same. Fatality rates among all groups rose throughout the rest of the decade after fentanyl was introduced, with deaths among white people often remaining higher. However, starting in late 2019 to early 2020, when fatal overdoses surged even higher across the board, the local Black community’s death rate rose at double the speed of that of white people.

Although drug overdose deaths rose throughout the Greater New Haven region in general, fatality rates for Black and Latino residents eclipsed those of white residents during the pandemic. (Courtesy of DataHaven)

In 2022, 133 people died of drug overdoses in the city of New Haven. 56 of the fatal overdose victims were Black, 31 were Hispanic and 45 were white. This breakdown shows deaths are skewed across the city’s ethnic communities: Black New Haveners make up about 33.9 percent of the city’s total population, but they comprised about 42 percent of the lives lost to overdoses that year.

Hurting communities and barriers to treatment

The News spoke to local addiction treatment experts and care workers who presented several social health determinants as explanations for the racial disparities in overdoses. 

Traci Norman, a program manager of Yale’s Addiction Treatment in the Black Community study, connected the disparities to other challenges that disproportionately affected Black people during and beyond the pandemic, including higher rates of underlying health issues, worsening mental health and civil unrest in response to structural racism and police brutality.

“Racism isn’t new… but seeing it in your face, seeing people getting murdered, hearing people being disproportionately impacted by COVID. And not knowing what’s going to happen tomorrow,” Norman said. “I think all of that compounding on one another definitely led to a lot of increased substance use, as well as relapses for some people, too.”

Former University chaplain Rev. Dr. Frederick J. Streets DIV ’75,  who works to support people of color in New Haven through addiction recovery, also emphasized an “explosion of racial animosity,” as well as the acute phase of the pandemic and political polarization, as stressors and sources of anxiety. These unique pressures and fears, Streets said, made many people turn toward self-medication. 

Depression, anxiety and other mental health problems surged across demographic groups during the pandemic. However, this rise did not impact all ethnic groups equally: according to the Datahaven report, Black and Latino individuals were 2.3 times and 1.6 times more likely to report feeling depressed than white people were, respectively.

“If you’re a person struggling with mental health or substance use history, now you’re isolated,” said treatment care worker Sylvia Cooper. “People are feeling like, ‘Am I gonna die? I have substance use, and I have health issues — it’s coming for me.’ So it really creates a hysteria of ‘what else is there left to do?’”

Beyond mental health stressors, physical health issues that disproportionately affect people of color were also exacerbated by the pandemic. COVID-19’s mortality rate among Black individuals was over double that of white people in the Greater New Haven region, according to the 2023 Datahaven report. Norman added that even though people of all racial backgrounds consume drugs and alcohol at similar rates, racial disparities regarding the incidence of other health complications caused a higher risk of overdose deaths for people of color.

“We typically have greater health challenges and health occurrences, underlying things such as hypertension rates, high cholesterol and diabetes, that also play a role in why we face greater mortality in regards to substances,” Norman explained. “I personally saw how black people were being disproportionately impacted by COVID-19.”

Local minority communities often see a lack of access to treatment services, especially as they face higher levels of economic inequality compared to white people. 

Assistant Professor of Psychiatry at the Yale School of Medicine Fabiola Arbelo Cruz said that barriers to care include a lack of physical proximity or transportation to treatment centers, high insurance costs, daily financial pressures and social stigma.

“If someone’s unemployed and with unstable housing, you give an appointment for a follow-up,” Arbelo Cruz explained. “But meeting the basic need of going to work and getting money might be a reason for them missing an appointment.”

Arbelo Cruz added that bed closures, long waitlists, limited walk-in appointments and reduced group therapy options also cut access to in-person addiction treatment centers. As these centers implemented social distancing regulations to protect patients from the spread of COVID-19, many of those struggling with substance use disorder — especially those who already faced barriers to in-person care —  also had issues accessing telehealth services. 

In a statement to the News, YSM Professor of Psychiatry Chyrell Bellamy also noted that Black and Latino people have less access to medication-assisted treatment for substance use disorder, which includes methadone and buprenorphine treatments that relieve withdrawal symptoms. 

According to one study conducted by JAMA Psychiatry, Black and Latino patients also tend to be prescribed MAT for shorter durations than white people do. Receiving MAT for an appropriate duration is often vital in patients’ survival — studies have shown that these medications may cut the overdose death rate in half among those struggling with opioid addictions, and receiving at least six months of treatment is associated with better recovery outcomes.

“We now have a very good treatment strategy for opioid use,”  Mark Costa, associate research scientist in psychiatry at the School of Medicine, told the News. “We have medication that is very helpful … But the way we offer these treatments is not impacting the Black and Latino community how it’s impacted the white community.”

The legacy of discrimination in clinical mental health and addiction treatment

Racial discrimination in the health care system has already long discouraged those of minority backgrounds from seeking treatment for substance use disorders, according to experts who spoke to the News. Datahaven’s 2023 CWI supports such claims — compared to 3 percent of white residents, 7 percent of Latino residents and 16 percent of Black residents in Greater New Haven reported that they had been discriminated against in the health care system. 

For Bridgett Williamson, who formerly battled substance use disorder and now works with those in recovery, the issue of racial discrimination and abuse in addiction treatment hits close to home. When she received methadone to treat her drug addiction in the 1980s and early 1990s, treatment workers said that one of her urine samples tested positive for drugs, even though Williamson maintains she did not consume any substances. She received an ultimatum from the criminal courts: be admitted to the state’s in-patient mental health treatment facility or go to prison for five years. 

When she entered the facility, staff members exerted control over what she could and couldn’t do. For instance, although they allowed white patients to step outside to smoke cigarettes or make trips to the store, they barred Williamson and other Black patients from doing the same. They told her they were afraid she wanted to step outside to purchase drugs, but they never raised this concern with the white patients — including those who Williamson said actually did bring drugs inside. 

Trapped on the third or fourth floor of the facility for over a month, Williamson’s mental and physical health deteriorated. She said she was forced to stay without any means of escape as she endured experiences that still traumatize her three decades later, including witnessing other patients harm themselves, finding mice in her bed and having her health and safety concerns constantly ignored by staff and doctors. 

“Caring and controlling is two different things,” Williamson said. “Do you think I trust the hospital? Hell no, I don’t even go. So that’s how they treat us people of color.”

Streets named a long history of suspicion toward traditional clinical care models among minorities that persists through the current crisis. Oftentimes, he told the News, people of color seeking help are cast as criminals and treated as “people who are problems” instead of people experiencing problems. 

Over 30 years after Williamson’s experience in the state facility, the state’s Department of Mental Health and Addiction services boasts a Health Disparities Initiative on its website. The page raises questions about a “culturally competent system of care” and asks readers to reflect on steps the Department has taken “toward developing culturally relevant programming.” 

At the same time, state mental health facilities collectively employ 70 police officers, many of whom show up to work armed. By having armed police officers on their premises, state mental health and addiction treatment centers may heighten the fear of seeking help among Black and Latino people in Greater New Haven, who were far more likely to report experiencing discrimination at the hands of the police in the Datahaven CWI. Only 45 percent of Black and 54 percent of Latino residents of Greater New Haven reported that they approved of the local police, as opposed to 76 percent of white residents. And although Black residents make up 16 percent of residents in Greater New Haven, they comprised 45 percent of drivers who were searched by police from 2018-2020.

The presence of police may also discourage people who have had previous experiences with the criminal justice system, Costa noted. The Yale-affiliated Connecticut Mental Health Center in New Haven, where Williamson was mandated to go decades ago, currently hosts a team of armed cops and features metal detectors at its entrance. 

Streets stressed that existing clinical models must prioritize hospitality toward minority patients in order to truly make them feel comfortable enough to receive medical care during a crisis. Clinical models, others added, must also become more accessible to all people struggling with addiction regardless of race or class.

“Here’s the dilemma: as you work and encourage people not to feel bad about feeling bad, not feeling bad about needing help, what happens when a person goes to a system that then treats them inhumane?’” Streets said. “It’s a catch-22.” 

Ethnic churches, multidimensional treatment and peer support

After coming to Connecticut for treatment, Bellamy’s cousin died from an overdose in August 2022. Bellamy told the News that she, her colleagues and other community members are motivated to work on “culturally responsive” treatment efforts because of their life experiences.

“​​I do the work because as a professor and as a person with my own lived experiences, we are all on a recovery journey either personally or with family, friends, neighbors, roommates, classmates, co-workers and colleagues,” Bellamy wrote to the News. “I know far too many people that hide their use of drugs because of the shame and fear of reaching out.”

Bellamy serves as the director of the Yale Program for Recovery and Health, or PRCH, which aims to foster inclusion and trust through culturally responsive approaches to care. These efforts often center around building connections between people in recovery and peer mentors of their own backgrounds who have been in recovery themselves. 

Williamson and Youins, who both work with PRCH, said their personal experiences with addiction drive their need to give back to others in the community through one-on-one mentoring. Williamson shared that sharing her experiences of substance use disorder and trauma helps demonstrate the realities of addiction in the long term, motivating people to continue recovery. It also helps combat the shame and stigma around substance use disorder on a more personal level, she said. 

“I stayed in the streets, I stayed in crackhouses, so this is why it’s so easy for me to let a person know that you don’t have to be ashamed for where you’ve been,” Williamson said. “I don’t care what you did three minutes ago. How can we move forward today, right now?”

Youins emphasized the importance of receiving care from people who “look like you,” especially as treatment and addiction recovery outreach efforts have often been led by white people “who have no connections in the community” and do not understand the social factors that influence substance use. He stressed that Black leadership has been crucial to bolstering recovery efforts in his community.

Created in 2017 by Bellamy and Assistant Professor Adjunct of Psychiatry Ayana Jordan, the Imani breakthrough project study was specifically designed to target people of color looking for recovery, though treatment for substance use is open to all. Using Black and Latino churches in the state, providers and care coordinators have tried to create a comfortable faith-based treatment environment while still being “non-proselytizing,” according to Streets, who helped facilitate the program at the Dixwell Avenue Congregational United Church of Christ.

“It’s a natural outgrowth of faith communities, as a matter of the basic principle and ethics of supporting the neighbor and assisting those who are more vulnerable,” Streets said. “It’s a public health approach, which combines the whole notion of empathy and an appreciation for our struggle as human beings.”

Dixwell UCC also promotes other community-centered approaches to combating the rise of substance use disorder and overdoses. The church has worked to educate congregation members about the the nature of substance use and the signs of potential suicide, as well as hosting trainings on administering Narcan and other harm reduction methods. Some congregation members have also stepped up to help lead the meditation sessions for those in addiction recovery through the Imani program.

“Those same people are advocates with their own families and in the wider community,” Streets observed. “If you replicate that by hundreds of churches or organizations throughout the community, you… advocate for a better atmosphere in which treatment can be offered and addiction could be understood.”

Gayle Brown began recovery treatment with Imani when she ran into a few counselors at Varick Memorial A.M.E. Zion Church about five years ago, right across the street from the Dixwell UCC. After the counselors asked her whether she knew anyone who had experienced substance use disorder, abuse, poverty or other hardship who would be interested in participating in a paid study, she boarded the bus and began spreading the word. Soon enough, she and dozens of other local residents gathered in Varick Memorial’s basement for their first session.

Shellina Toure, left, and Jeanette Reynolds show some of the Imani program materials they use at Varick Memorial A.M.E. Zion Church. (Megan Vaz, Contributing Photographer)

Cohorts of patients have gathered to receive weekly treatment through education on the harms of substances and racial disparities in overdoses, computer-based cognitive behavioral therapy, group support, a clinical treatment program staffed with doctors, one-on-one wellness coaching and self-reflection exercises. 

Shellina Toure, who currently facilitates the program at Varick Memorial with Sylvia Cooper, said that the self-reflection activities that happen during sessions are “intense.” Her facilitator training, which featured the same mindfulness strategies as the treatment sessions, had such a strong impact on her that it brought back her memories of almost becoming addicted to painkillers.

The church setting and group component, which Toure said becomes more comfortable as people build relationships over the course of several weeks, can help combat much of the distrust associated with traditional addiction treatment in hospitals. The room used for treatment also features a “Comfort Zone Agreement” on the wall, which Toure said instills ground rules and a culture of mutual respect during sessions. 

Sessions, Brown said, prioritize seeing one’s own experiences through the lives of others and understanding why they experience substance use disorder. As she continued to engage in self-reflection and open dialogue with others, Brown unearthed experiences from her traumatic childhood and her family’s history of addiction, reckoning with their influence on her life in the present.

“All of the people that was in this one program at that one time — I could fit into each one their shoes,” Brown said. “I’ve been through it, mentally abused, physically abused, sex abused. After all these many years, it started bringing up my childhood, what happened to me.”

The program also directly targets the social determinants that put minorities at a higher risk for fatal overdoses, aiming to provide people with basic needs to eliminate barriers to treatment access. Toure said she has personally helped patients find emergency housing, look for rental assistance programs, earn their high school diplomas and get their driver’s licenses.

Gayle Brown began attending recovery treatment at Varick Memorial A.M.E. Zion Church about five years ago. (Megan Vaz, Contributing Photographer)

Brown said that most people in the program are doing better now than they were when they first entered it. The program, she confirmed, has connected people with jobs at Yale and other employers, housing and financial help — setting them up for long-term wellness.

The Varick Memorial facilitators and Arbelo Cruz, who works as a provider in Latino churches hosting the program, added that the Imani program is especially effective at keeping patients in treatment because it does not impose specific goals onto them. For many, Arbelo Cruz attested, a move in the right direction might look like reducing use from eight bags of heroin per day to two, or going from three bottles of wine per day to one. There is no “friction” between what the patient wants and what the provider wants.

Brown attested to this, recalling “life-death situations” like the time where one of her fellow cohort members overdosed during a session. Immediately, the rest of the group sprang into action, calling emergency services and watching as responders “brought him back to life” with Narcan. They quickly welcomed him back with open arms.

“When one of the guys fell out with the fentanyl and came to us, we cried and we told him, ‘you slipped, but you get back up,’” Brown said.

Varick Memorial is located at 242 Dixwell Ave.


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