We Cannot End Overdoses Until We Achieve Racial Justice: Q&A with Julie Rwan

As the Senior Manager for the Overdose Prevention Program’s work in Michigan what was your immediate reaction to these steps taken by the Governor Whitmer?

Governor Whitmer is taking a necessary step towards health equity and racial justice with the recent executive actions. Michigan joins a growing list of cities, counties, and states declaring racism as a public health crisis, following statements by the APHA and American Medical Association (AMA) naming racism as a form of systemic violence that must be eliminated. Michigan is initiating changes in policy and practice and paving the path to dismantle racism and achieve health equity.

Conversations about race and racism have been at an all-time high lately. Why is it important to talk about race and racism when discussing public health issues like drug overdose?

Racism, as a systemic and ongoing assault on physical and mental health, is important to all public health issues. It is certainly central to the issue of drug overdoses, where we see disproportionate impacts  by race. While overdose deaths decreased for white Michigan residents by 6.5% between 2017 and 2018, black residents experienced a 14.7% increase, and the highest rates of overdose overall compared to any other race group. Preliminary data shows that emergency medical service calls for overdoses have increased during the COVID-19 pandemic, with black Michiganders experiencing nearly double the rate of overdoses compared to white residents. The emergence of COVID-19 is highlighting how racism is compounding multiple health crises in Black communities.

The racial disparities in overdoses are driven largely by the “war on drugs” – a racialized and discriminatory set of drug criminalization policies and practices resulting in mass incarceration and contributing to the “under-resourcing” of communities of color. Instead of punishing drug use, communities can thrive with supportive social and health responses such as access to harm reduction-oriented services offering safer drug use supplies, naloxone to reverse opioid overdoses, opioid agonist medications, and supportive engagement. These life-saving health services should be accessible in communities harmed by the systemic racism of the drug war.

Data from the Michigan Department of Health and Human Services (MDHHS) indicates that overdose deaths in the Black community are not decreasing as they have for other populations across the state. Do you think this Executive Directive and the Executive Order will help address some of these health disparities?

The combination of executive actions forms the foundation for the challenging work of identifying and meaningfully addressing racism and resulting disparities. The Executive Directive tasks Michigan Department of Health and Human Services with collecting and analyzing data on racial disparities. This is a vital step in understanding the extent of racism’s impact on health, from measuring overdose morbidity and mortality to mapping access to quality care. The Executive Order tasks the Black Leadership Advisory Council to recommend policies and laws for ending racial inequity in health care, among other areas. And both bodies will be working alongside Black communities to develop community-driven responses, which is key to creating impactful and sustainable change.

In addition to this directive and order, what has the state of Michigan done to address and reduce overdose deaths?

Governor Whitmer has demonstrated a commitment to health equity initiatives for reducing overdoses and supporting people who use drugs. In 2019, the Michigan Opioids Task Force, led by MDHHS, was formed with the goal of reducing overdose deaths by half over the next five years. Achieving this goal will save Black lives, as overdose rates are highest in Black communities. Specific initiatives include creating an online naloxone portal for community organizations to request free naloxone, supporting and expanding syringe services programs, increasing access to medications for opioid use disorder, and supporting targeted outreach for communities of color.

MDHHS recently convened a virtual harm reduction summit bringing together local and national experts to expand statewide capacity for serving people who use drugs. Racial equity was a top theme at the summit, with community organizations leading the way in navigating the systemic racism in healthcare, social services, and criminal justice settings. The commitment for preventing overdoses and addressing racism was palpable, even virtually!

How is Vital Strategies advancing health equity and racial justice through the programs we support ?

The Overdose Prevention Program at Vital Strategies is working with state agencies including MDHHS to eliminate racial disparities by implementing the Michigan Opioids Task Force recommendations, strengthening data capacity, increasing access to opioid agonist medications, and supporting harm reduction programs. Our work sits at the intersections of racism and drug criminalization, and we cannot end overdoses until we achieve racial justice.