ABSTRACT
The United States is in the midst of an overdose crisis of tremendous proportions. Even before overdose death rates spiked sharply during the COVID19 pandemic, the United States had twice the mortality rate of the second highest country, and 20 times the global average.1 Deaths from overdose have increased year after year-nearly uninterrupted-for the past four decades. During the pandemic, the United States crossed the grim milestone of 100 000 overdose deaths in a 12-month period. Although overdose deaths have increased for all racial/ethnic and socioeconomic groups, these increases have not been felt equally among all Americans. Overdose and addiction have long predominated among low-income communities,3 and during the "first wave" of the overdose crisis in the early 2000s, deaths were concentrated in low-income White communities.4However, the racial/ethnic profile of the US overdose crisis has changed sharply.5 In 2020, the overdose death rates of Black individuals overtook those of White individuals and now exceed them by nearly 20%. American Indians/Alaska Natives now have the highest overdose mortality rates of any group-30% higher than for White individuals. Far from a "White problem," overdose prevention is now a key racial justice issue. In this issue of AJPH, an analysis of a national data set by Pro et al. (p. S66) considers the individual- and state-level factors that help explain racial disparities in addiction treatment. Economic and community distress-including low education, high unemployment, and housing vacancy-had the strongest negative relationship to treatment success across all racial/ethnic groups. Black and American Indian/Alaska Native patients disproportionately presented for treatment in mid- to high-distress communities. Black patients were also much more likely to experience poor treatment outcomes. In addition, patients in states that have not expanded Medicaid were less likely to experience successful treatment.