Data Narrative

Framing the Project

Our Hypothesis

We hypothesized that drug usage would be shown to disproportionately affects minority and underserved communities. A large body of research demonstrating greater incidence of substance use disorders among these groups lends credence to this theory. Poverty, prejudice, and restricted access to healthcare are examples of social variables that greatly increase a person's susceptibility to drug use, thereby increasing risk for fatal overdoses. Taking an intersectional stance recognizes that people from underprivileged groups are at additional risk due to compounding inequities across socioeconomic class, gender, and race.

Theoretical Approaches: Critical Race Theory and Intersectionality

We are thinking first and foremost through the lens of Critical Race Theory (CRT), which offers a framework for examining the ways that systemic injustices and structural racism affect the incidence of opioid overdoses that differ between racial and ethnic groupings. It illuminates the ways in which historical, social, and economic factors converge to influence healthcare access, socioeconomic standing, and exposure to risk factors linked to substance abuse. Beyond a simple consideration of race, CRT “questions the very foundations of the liberal order, including equality theory, legal reasoning, Enlightenment rationalism, and neutral principles of constitutional law” (Delgado and Stefanic, 1). 

Using CRT also extends to an intersectional approach, enabling us to think about the complex ways that race interacts with other social identities, which may also be factors in opioid use disorder. This perspective helps us understand the particular vulnerabilities that certain oppressed communities may face. CRT also helps us examine the power relationships that exist within policy frameworks and healthcare systems, emphasizing the ways in which racial hierarchies impact treatment access, stigma, and the criminalization of drug use. It offers a starting point for refuting skewed narratives and promoting policies that deal with institutional racism in the medical field. CRT particularly grounds our project because of its emphasis on activism, not only trying to understand the social context underlying disproportionate trends in drug use and narratives surrounding it, but also trying to change structures that enable them.

Theoretical Approaches: Critical Disability Studies

The lens of Critical Disability Studies (CDS) helps us examine the ways in which drug use and recovery are stigmatized, and how individuals' experience of stigma can also be influenced by the intersections of disability with other identities, such as race, gender, and socioeconomic background.

By challenging conventional beliefs about ability and health, CDS “designat[es] (dis)ability as a system of social norms which categorizes, ranks, and values bodyminds and disability as a historically and culturally variable category within this larger system” (Schalk, 2). Thus, we can use this framework to challenge the pathologization of substance use disorders, as well as unpack stigma around addiction stemming from the use of opioids for chronic pain relief. It highlights the importance of accessible treatment, inclusive healthcare practices, harm-reduction strategies, and acknowledgement of the various social determinants of health. 

Historical Timeline

Sources: "War on Drugs," "You can help reverse the overdose epidemic," "Drug War History," and "Evidence on Strategies for Addressing the Opioid Epidemic."

Stories From Our Data

Racial indicators of general overdose risk

Historical patterns in the data can be used to understand how systemic disparities along racial lines impacts the rate of fatal overdose in different communities. Our data confirms that race is a significant indicator of overdose risk, with current data showing that Black and Indigenous populations are at the highest risk for fatal overdoses (See Fig. 1).

Through the lens of Critical Race Theory, we can understand the disparity across different racial groups as a product of systemic racism. Additionally, certain racial groups are more prone to experiencing certain socioeconomic inequities, meaning there are other non-racial variables that are correlated with increased overdose risk, which themselves may be correlated with race. For example, one 2020 study found that various socioeconomic variables, such as being male, being disabled, not having attended college, not having health insurance, being a renter, being a U.S. citizen, being incarcerated, living below the poverty line, and/or living in a South Atlantic or Mountain state increased one’s risk for fatal opioid overdose (Alterkruse).

Examining the role of fentanyl

It is important to note that increases in overdose rates among all racial populations can be largely attributed to the introduction of synthetic opioids (fentanyl) into the drug supply. Comparing the “Overdoses by Ethnicity” graph above and the “Synthetic Overdoses by Ethnicity” graph below, we see that the growth in overdose rates post-2013 can largely be attributed to fentanyl (see figure 2). Moreover, the data also shows that while all populations were affected by increased fentanyl usage, since 2020, Black and Indigenous populations have been disproportionately affected by fentanyl when compared to White populations who, prior to 2020, were more similarly affected. 

Where fentanyl  hides

These data are read in the context of above data, so we know that fentanyl is already driving overdoses at these points. The goal of the visualization is to understand how fentanyl is being consumed in combination with other drugs. As revealed in Figures 3 and 4 below, the rates of prescription and synthetic opioids are largely decreased, with stimulants and psychostimulants taking up a much larger portion of the ratio. So, why are stimulants and psychostimulants getting involved with synthetic opioids? A 2023 UCLA Health study found that since better quality stimulants are on the market, they are being used more. However, these stimulants are also laced with fentanyl. The use of these laced stimulants disproportionately affects Black and Indigenous communities, thus revealing how these disparities are causing a drastic increase in stimulant-synthetic deaths, and therefore, overall opioid deaths (UCLA Health). 

Additionally, this study addresses how fentanyl is being added to drugs to make them "stronger and more addictive." This source also talks about fentanyl being sold as Xanax and Oxycodone ("You can help reverse the overdose epidemic", 1:45)

2017 was the end of the first peak that started in 2013. 2022 is the most recent data we have. Even in this short time, we can see that fentanyl is increasingly showing up in stimulant-related deaths. Previously, prescription opioids and heroin were more involved, but that's no longer true.

Figures 3 and 4. Pie charts showing U.S. synthetic opioid-related overdose rates from ages 15-24 in 2017 and 2022, respectively, broken down by combinations of substances. “Synthetic Opioid Combination Overdose Rate Ages 15-24 (per 100,000).” Graph produced by Jacob Goldstein, June 25, 2024, screenshot, Tableau. For a more detailed view of this graph, visit our visualization page. 

Increasing overdose rates due to COVID-19?

The disproportionality we have seen thus far in the data starting in 2020 seems to be explained by the onset of the COVID-19 pandemic, although researchers are still unsure of what specific socioeconomic factors related to the pandemic may be related to the rise in fatal overdoses (Wagner). Nonetheless, knowing that socioeconomic factors have been heavily linked to who has been most affected by COVID-19, we can extrapolate that similar factors may be implicated in, or compiling upon, factors related to rising rates of fatal overdose. 

Implications of the Data

Re-examining historical drug policies 

This data helps us critically examine historical approaches to reducing overdose rates, allowing us to understand why certain policies have failed to achieve their desired impact. Historical research shows how reactions to drug crises have changed over time due to patterns of criminalization, medicalization, and stigma. Previously, drug-related policies have aimed to crack down on overdoses by criminalizing drugs, increasing policing, and seizing drugs to limit the supply ("War on Drugs"). However new data suggests that punitive measures to decrease drug use may actually be correlated with higher rates of fatal overdose. For example, a recent study showed that police seizures of drugs were actually correlated with higher incidences of fatal overdoses. Researchers hypothesized that this was due to the fact that users may seek out new drug sources, which may contain much more dangerous substances such as fentanyl ("Fatal overdoses increase after police seize drugs"). Thus, it is important to recognize that increases in policing and surveillance can be actively detrimental to communities in need. 

In the context of history, the issue of opioid overdose and its disproportionate effects on different aspects of identity is significant because it highlights ingrained societal injustices and institutionalized prejudices that permeate law enforcement procedures. Particularly when it comes to drug-related charges, inaccurate data or biased interpretations of data might dangerously contribute to disproportionate policing. For instance, biases in reporting, medical diagnoses, or law enforcement tactics that disproportionately target particular racial or socioeconomic groups may be reflected in past data on drug use and overdose rates. These prejudices have the potential to exacerbate social injustices and prolong cycles of inequality by resulting in over-policing and harsher sanctions for marginalized communities.