On March 24, Coach Charles Knox, a high-energy brother known for his peppy step and warm outgoing personality, stopped his workout, turned on his phone and delivered a tough and sobering message to his Facebook friends.
March 24 would have been his son Charles “Toast” Knox Jr.’s 36th birthday, but instead of celebrating Toast’s birthday, Knox Sr. was sharing how much he missed his son and telling others to beware. Toast died, January 30, 2021, from what is believed to be an opioid overdose.
Coach Knox, said he decided to record the message because he missed his son; the two had been close all of Toast’s life, but he’d also found two more of his former Team of Hard Knox wrestlers had overdosed in the last year.
While one had succumbed, the other was lucky enough to have naloxone, a medicine that rapidly reverses an opioid overdose, readily at hand.
Knox’s findings reflect a growing trend that so far isn’t getting much attention in African-American communities: African Americans are dying from opioid-related deaths at exceptionally high numbers.
Remember when opioids used to be a White person’s addiction? Now, African Americans are overdosing at a higher rate than Whites.
In 2020, the first year of the COVID-19 pandemic, the rate of drug overdose deaths among Black Americans surpassed that of Whites for the first time since 1999 — a sharp reversal of the situation a decade earlier, when rates were twice as high for Whites as for Blacks, new UCLA research shows.
The overdose rates for all ethnic and racial groups have increased rapidly. In 2020, Native Americans/Alaska Natives experienced the highest overdose death rate and were, along with Blacks and Latinos, among the groups with the largest increase in overdose deaths per 100,000 people over the previous year. Death rates for all four racial and ethnic groups studied, including Whites, not only climbed in 2020 but climbed higher than in any single year prior, the researchers said.
These grim overdose statistics are driven in part by the wide availability of synthetic opioids and other highly toxic drugs.
Between 2009 and 2019, overdose deaths in the United States involving opioids and stimulant drugs, such as cocaine and methamphetamine, surged compared to deaths from stimulants alone.
Fatalities linked specifically to cocaine combined with opioids rose by nearly 450%, an alarming trend fueled by the growing contamination of non-opioid drugs with fentanyl, an extremely potent synthetic opioid. By 2019, more than three-quarters of deaths involving cocaine and half of those involving methamphetamine or other stimulants also involved opioids.
Altogether, between April 2020 and April 2021, the Centers for Disease Control counted 75,673 opioid overdose deaths – vs 56,064 the year before.
Cocaine and Fentanyl
It’s this combination – stimulants with opioids – that’s killing African Americans at the highest rate … and the favorite mix of African Americans is cocaine and fentanyl and it’s killing us.
In the first study of its kind, researchers from NYU Grossman School of Medicine and Wake Forest University School of Medicine analyzed the trend of rising opioid and stimulant deaths by racial and ethnic groups and by state. The findings, published online Feb. 8, 2022, in the American Journal of Epidemiology, indicated that while overdose deaths from opioids and stimulants rose across all racial groups and across the country, opioid and stimulant deaths among Black Americans increased at more than three times the rate as non-Hispanic White people. The analysis also found a significant increase in overdose opioid and stimulant deaths among Hispanic and Asian Americans.
The team of investigators found that between 2007 and 2019, the rate of Black Americans dying from opioids and cocaine climbed by 575%, compared to 184% among White people. While mortality from methamphetamine and other stimulants (MOS) remained at lower levels in 2019 than cocaine and opioid mortality, it has increased dramatically in recent years among Black Americans. MOS and opioid mortality rose 16,200% in Black people versus 3,200% in White people.
“While all racial and ethnic groups we examined are dying in greater numbers from opioids combined with stimulants, we are alarmed to see these trends worsening so much faster in marginalized communities that have historically been less affected by the current epidemic,” says Tarlise Townsend, PhD, a postdoctoral researcher at the Center for Opioid Epidemiology and Policy in the Department of Population Health at NYU Langone, and lead author of the study. “We need to be targeting harm reduction and treatment strategies to those who are being hardest hit.”
Crafty Drug Dealers
Kenneth Holloway, the clinical director at Restoration Knox Treatment Center (no connection with Coach Knox), says he sees the lucky ones who’ve survived an overdose. While some of the center’s clients are addicted to opioids, others, he said, have come across it unknowingly.
Holloway says dealers are often slipping fentanyl into cocaine and other drugs as a cheap way to stretch the drug and as a result cut their costs and also as a way to increase their customer’s high and addiction.
“It’s being slipped in the heroin that’s floating around, it’s being slipped into the cocaine,” said Holloway.
One of the lucky ones Holloway had in his class was a young lady who was out on a date with a guy who gave her some cocaine.
“She thought she was snorting cocaine. She had snorted some cocaine before and snorted this, and it had fentanyl in it,” said Holloway. “It almost killed her.”
She overdosed and ended up in the hospital.
The story Holloway shared and the study’s findings raise some important public health challenges.
People who primarily use stimulants and run across them “slipped” into other drugs are less likely to have or obtain opioid-related harm reduction products such as fentanyl test strips and take-home naloxone.
Nothing to Experiment With
Even individuals who know they may be taking a stimulant laced with an opioid are at risk because drug dealers aren’t always very consistent scientists. They may not always be precise in the amount of fentanyl they slip in and this is where the drug gets especially deadly.
The Drug Enforcement Administration states that about 2 milligrams of the pure substance are sufficient to be considered a lethal dose. Among confiscated pills that have been illegally distributed and tested for fentanyl, approximately 42% of them have been 2 milligrams or higher.
“It ain’t nothing to be experimenting with,” said Holloway. “You know we’ve all experimented with marijuana, taking a pill, or alcohol; even snorted some cocaine, but this ain’t nothing to play with.”