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Principle 4

Focus on Racial Equity

States and localities should direct significant funds to communities affected by years of discriminatory policies and now experiencing substantial increases in overdoses.

Although communities of color experience substance use disorders at similar rates as other racial groups, in recent years the rate of opioid overdose deaths has been increasing more rapidly in Black populations than in white ones. Additionally, historically racist policies and practices have led to a differential impact of the epidemic. In particular, people of color are more likely to face criminal justice involvement for their drug use. Black individuals represent just 5% of people who use drugs, but 29% of those arrested for drug offenses and 33% of those in state prison for drug offenses. Additionally, American Indian and Alaska Native (AI/AN) people are overrepresented amongst incarcerated populations. However, inconsistency in data collection for this population does not provide an accurate estimate on the percentage of AI/AN incarcerated for drug offenses. Communities of color are also more likely to face barriers in accessing high-quality treatment and recovery support services.

In addition to Black populations, other racial/ethnic groups are also seeing disproportionate increases in overdose related deaths. According to the CDC, in 2021 American Indian and Alaska Native people had the highest rate of overdose deaths in the country with a 39% increase from 2019-2020. However, inconsistent data collection and reporting on American Indian and Alaska peoples suggest that this may be an underestimate.

These disparities have contributed to ongoing discrimination as well as racial gaps in socioeconomic status, educational attainment, and employment. Without a focus on racial equity when allocating state settlement funds, localities run the risk of continuing a cycle of inequity.

In addition to state/local funds, federally recognized Tribes within the United States will also be receiving settlement payments from manufacturers, distributors, and pharmacies over the next 15 years. Tribes are slated to receive over $1.5 billion from these settlements to be used towards abating the opioid crisis in their communities. The Center for Indigenous Health at the Johns Hopkins Bloomberg School of Public Health working in collaboration with an expert Indigenous Advisory Committee created a set of Tribal specific Principles. These Principles provide guidance for tribal communities to inform decision making of opioid litigation settlement funds relevant to the unique settings of each tribal community. To read the Tribal Principles and learn more, visit:

How can Jurisdictions Adopt this Principle?

  1. Invest in communities affected by discriminatory policies.

    Historical patterns of discrimination will take sustained focus to overcome. Jurisdictions should fund programs in communities of color that will tackle root causes of health disparities and eliminate policies with a discriminatory effect.

  2. Support diversion from arrest and incarceration.

    Localities should:

  • Elevate and expand diversion programs with strong case management and link participants to community-based services such as housing, employment, and other recovery support services.
  • Fund community-based harm reduction programs that provide support options and referrals to promote health and understanding for people who use drugs
  • Increase equitable access to treatments for opioid use disorder including medications for opioid use disorder.

3. Fund anti-stigma campaigns.

Stigma against people who use drugs is pervasive and frames drug use as a moral failure. This stigmatization may contribute to the use of discriminatory punitive approaches to address the epidemic, particularly among communities of color, as opposed to more effective ones grounded in public health. In order to address this, jurisdictions should use funds to support campaigns based in evidence that reduce stigma.

4. Involve community members in solutions.

Jurisdictions should fund programs in communities of color with diverse leadership and staff and a track record of hiring from the surrounding neighborhood. Programs with a diverse workforce of staff, supervisors, and peers are more likely to provide relatable and effective services.