More Than Numbers: The Overdose Crisis Facing Black Women

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by Mahogany Speaks to You l April 9, 2025

The opioid epidemic has taken over a million lives in the United States since 1999. But behind the headlines lies a troubling reality: the growing crisis of Black women and overdose deaths. While overdose rates are rising across the board, Black women are experiencing alarming increases that often go unnoticed. This crisis is not just about substance use—it’s a reflection of deep, systemic inequalities in healthcare, housing, justice, and access to support. Addressing it requires more than awareness—it demands action, compassion, and solutions rooted in equity.

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The Crisis by the Numbers

In 2023, the overdose death rate for Black non-Hispanic people reached 48.9 per 100,000—much higher than the 33.1 per 100,000 seen in White non-Hispanic populations. Between 2019 and 2020, Black overdose death rates soared by 44%, while the increase for White individuals was just 22%. And while overdose deaths have recently dropped for White populations, they continue to rise for Black communities.

When it comes to Black women, the data is even more alarming. In Wisconsin, overdose death rates for Black women jumped from 21 per 100,000 in 2018 to over 32 per 100,000 in 2020. For women aged 65 to 74, Black women had the highest overdose death rate nationally in 2020—12 per 100,000.

It’s not just older women who are at risk. Between 2019 and 2020, overdose deaths among Black youth aged 15–24 increased by 86%. These numbers reveal a tragedy that is affecting Black women and girls across all generations.

Why Are Black Women More at Risk?

Understanding the overdose crisis means understanding the systems that create risk. The rise in overdose deaths among Black women is not about personal failure. It’s about systemic failure. Here are some of the key drivers:

1. Health Care Access and Racial Bias

Even with insurance, Black women often face bias and mistreatment in medical settings. Many report being dismissed, ignored, or misdiagnosed. When it comes to substance use treatment, studies show that Black individuals are less likely to receive adequate care like Medication-Assisted Treatment (MAT), even after experiencing an overdose. A shocking study revealed that only 8% of Black individuals who died from overdose had documented access to substance use treatment despite having similar medical histories as White individuals who did receive help.

Why Does My Healthcare Feel Different? Understanding Racial Bias in Medicine

If you’ve ever felt dismissed, unheard, or misunderstood during a medical visit, you’re not alone—and it may have more to do with racial bias than you realize.

What Is Racial Bias in Healthcare?

Racial bias in healthcare refers to the unequal treatment patients may receive based on their race or ethnicity. Sometimes it’s obvious, but more often, it shows up in quiet ways—like a provider not listening carefully, underestimating your pain, or making assumptions about your lifestyle or background.

This bias can be:

Explicit – when someone knowingly treats a person of color unfairly.
Implicit (unconscious) – when healthcare workers make decisions influenced by stereotypes they may not even realize they hold.

Both can lead to differences in care—whether it’s being offered fewer treatment options, waiting longer for a diagnosis, or receiving lower-quality pain management.

Real Examples of How Bias Shows Up:

Black women are more likely to die from pregnancy-related complications than white women, often due to their pain and concerns being ignored or minimized.
Latino and Indigenous patients may be less likely to be offered language services or fully explained procedures.
Asian American patients may have symptoms overlooked because of stereotypes that suggest they’re always healthy or compliant.
Native American communities often face systemic barriers to access, compounded by historical trauma and underfunded care.

These differences are not because of genetics or culture—they’re rooted in a history of unequal treatment and systemic neglect.

What You Deserve—and What You Can Do

Every person deserves to be heard, respected, and properly cared for—no matter their race or background.

If you ever feel something isn’t right:

Speak up about your symptoms and advocate for second opinions when necessary.
Bring a trusted support person with you to appointments.
Request a different provider if you don’t feel safe or respected.
Ask questions until you feel fully informed and involved in your care.

Awareness is power. Understanding racial bias in healthcare doesn’t solve everything—but it gives you the clarity to push for the care you deserve.

2. Poverty and Social Conditions

Black women are more likely to face poverty, unstable housing, and limited job opportunities—all of which are major stressors that can increase the risk of substance use. A county’s income inequality is directly tied to overdose rates, especially in Black and Hispanic communities. Without transportation, childcare, or safe housing, getting help becomes nearly impossible.

3. The Criminal Justice System

The “war on drugs” has devastated Black communities. Though drug use rates are similar across racial groups, Black people are far more likely to be arrested and incarcerated for drug-related offenses. Being released from jail or prison—especially without access to treatment—creates a high risk for overdose, due to decreased tolerance and disrupted support systems.

4. Racism, Trauma, and Mental Health

Systemic racism leads to chronic stress, anxiety, depression, and PTSD. Black women often carry the emotional weight of caregiving, discrimination, and trauma—without access to culturally sensitive mental health care. During the COVID-19 pandemic, these pressures intensified, and overdose deaths among Black people surged.

5. Dangerous Drugs and Drug Mixing

Illicit fentanyl is a major threat. This synthetic opioid is often mixed into cocaine, meth, or fake pills—without users knowing. Polysubstance use (mixing drugs) is also rising. In Texas, overdose deaths involving both opioids and cocaine quadrupled for Black Texans between 2010 and 2019. These combinations make overdoses more likely—and more deadly.

The Role of Intersectionality

Black women face overlapping barriers because of both race and gender. They may deal with stigma around substance use, especially if they’re mothers. Caregiving duties, financial hardship, and a lack of trustworthy care providers all contribute to overdose risks. Standard treatment programs often ignore these realities, making recovery even harder.

Worse, national data often fails to break down overdose numbers by both race and gender. This makes it harder to understand the true impact on Black women and harder to design solutions that actually work.

What Can We Do? Solutions That Center Black Women

Despite these challenges, there is hope. Black communities have long been resilient, creative, and powerful. Here are five ways we can address the overdose crisis while centering the needs of Black women:

1. Support Community-Led Solutions

Black women with lived experience must be at the center of any response. Local, Black-led organizations already doing the work need funding and support. They understand the community’s needs and are often more trusted than large institutions.

2. Demand Culturally Responsive Treatment

Treatment programs must respect cultural differences and lived experiences. That means hiring providers who reflect the community, offering trauma-informed care, and addressing social needs like housing and childcare. Trust matters—and care must be designed with Black women in mind.

3. Expand Harm Reduction Services

Harm reduction saves lives. That includes:

Free and widespread access to Naloxone (Narcan)
Syringe Services Programs (SSPs)
Fentanyl Test Strips
Education on safer substance use, without stigma

These tools must be accessible in Black neighborhoods—no barriers, no judgment.

4. Improve Treatment Access and Retention

We need better access to high-quality, culturally competent substance use treatment. That includes more MAT options, insurance reform, and treatment availability inside and after incarceration. It’s not just about getting into treatment—it’s about staying in and being supported throughout recovery.

5. Advocate for Systemic Change

Lasting impact requires bold policy changes:

Healthcare: Mandate anti-bias training, expand Medicaid, and diversify the workforce.
Justice Reform: End mass incarceration, decriminalize personal drug use, and invest in diversion and reentry programs.
Economic Justice: Push for affordable housing, living wages, and access to education.
Better Data: Require overdose data to be broken down by race, gender, and location.

A Call to Action

Black women are dying from preventable overdoses. This isn’t just a health issue—it’s a justice issue. By centering Black women’s voices, investing in community-led care, and demanding systemic change, we can turn the tide.

This epidemic is more than numbers—it’s personal. These are our mothers, sisters, daughters, friends. It’s time for an urgent, equity-centered response that values every life and ensures that healing is possible for all.

If you or someone you know is struggling with substance use, help is available. Call the SAMHSA National Helpline at 1-800-662-HELP (4357). It’s free, confidential, and available 24/7.