The opioid crisis has dramatically shifted its impact on Black communities in recent years, yet treatment resources haven’t followed. In North Carolina, overdose death rates among Black residents more than doubled between 2019 and 2021, reaching 38.5 per 100,000 people. The surge is largely driven by fentanyl contaminating drug supplies.
Despite growing need, significant treatment gaps persist. In 2019, white people comprised 88% of those served by North Carolina’s federally funded opioid programs, while Black people—24% of the state’s population—represented just 7.5% of recipients. Nationally, Black people are half as likely as white people to receive treatment referrals, even after surviving an overdose.
Nora Volkow of the National Institute on Drug Abuse notes that Black patients typically receive treatment five years later than white patients. “Five years can make the difference between being alive or not,” she said.
Treatment disparities extend to medication access. Black patients overwhelmingly receive methadone, which requires daily clinic visits, while white patients receive buprenorphine three to four times more often—a medication that can be prescribed in office settings and filled at pharmacies.
the problem. Many Black people fear that seeking help could lead to criminal justice involvement, job loss, or losing custody of children. Edwin Chapman, who runs a Washington, D.C. addiction clinic, reports that insurance companies impose more restrictions on urban patients, including prior authorization requirements that delay care.
See: “Hit Hard by Opioid Crisis, Black Patients Further Hurt by Barriers to Care” (April 2, 2025)
