Kai: I'm Kai Wright in for Tanzina Vega, who returns to the host chair tomorrow. You're listening to The Takeaway. When the opioid overdose crisis was declared a public health emergency in 2017, much of the attention focused on the most affected population at the time, white communities abusing prescription drugs, but in recent years, communities of color, particularly Black and Latino communities, have seen a rise in opioid abuse and overdose. The crisis has reached such a point that last year the US government, through the Substance Abuse and Mental Health Services Administration, deemed it an urgent issue.

Since the pandemic began, the CDC has reported a dramatic rise in overdoses overall. Although we don't have a complete picture of what this looks like for the Latino community specifically, with communities of color struck hardest by the pandemic, we may also be seeing a rise in overdoses for Latino communities. Helping us break down what we do and do not know so far is Irene Falgás Bagué, a psychiatrist and researcher at Harvard Medical School. Irene, thanks for joining us.

Irene: Thank you, Kai.

Kai: Can we start with the report that you helped produce? You run the committee that produced the report from Substance Abuse and Mental Health Services Administration last year. What were your findings?

Irene: This report was made because there was a big need for understanding what was happening with the Latino population. The report was written mostly during 2018, that's before the COVID pandemic, and mainly was made to help health workers and people working with Latinos with substance use disorders and opioid use disorders, managing, understanding and giving more tools on how to manage the disorder on this specific population because their needs are specific. One of the main findings is actually that, that we need cultural sensitive treatments and ways on addressing the crisis for Latinos.

Kai: Are there specific parts of the community we're talking about here with this concern in terms of age or even nationality?

Irene: Yes. Some of the important things of knowing about the Latino population is that it's very genetic, and just being aware of that, it's the first step that we need to acknowledge. It's different if we talk about Mexican America compared to people that are coming from other countries in Central America, for example. In terms of ages, what we know is that the main opioid user in the Latino population are people in younger ages starting at age 12 up to age 22. These are the population at highest risk of opioid overdose and opioid initiation right now. These are, most of them, US-born.

Kai: With the pandemic now, what do we know about the rising rates of opioid overdoses generally, around the country?

Irene: We are seeing a skyrocketing of the numbers of overdose deaths in general, but mostly in the Latino subgroup, which is a worrying sign. For example, just we have data up to August 2020. We still are missing half of the year data on 2020, but we know that already up to August, we have seen an increase around 16% and it's mostly based on the Latino. We know, for example, that in states as Maryland, where they do a good tracking of the opioid overdose deaths, that the Latinos account for almost a 30% of the total of the increase. We see that there's a 16% overall, but a 30%, it's on the Latinos. It's a much acceleration of the increase of overdose deaths among the Latino subgroup.

Kai: Irene, we were talking about how opioid overdoses in Latino communities are on the rise. Do you know anything about what type of opioids Latinos have been using? Is that different than other populations or is it all the same thing?

Irene: Our opioid epidemic has started with opioid medication, prescribed medication, and that has switched to heroin in the first. Then now later on, it has moved to fentanyl and other psychostimulants that are not opioids such as methamphetamines. What we know from the latest data regarding the Latino population, it's mostly the overdose deaths are related to fentanyl and methamphetamine. It's pretty similar to what is happening to other groups.

Kai: To put a fine point on that, what we have known in the past is that the fentanyl is what leads to overdoses more often than other types of opioids. We're seeing that Latinos, that's what these young Latinos are using.

Irene: Correct. We know that during the COVID epidemic, that heroin import has been reduced. Fentanyl and methamphetamines are produced and they have been circulating in the country more than heroin. That's also a reason why we are seeing this rise on fentanyl, which is much more lethal.

Kai: What is to be done about this? What are some of your research tell us about what are the solutions?

Irene: Thank you for asking that. I think that the most important thing is that we think about how our healthcare can be adapted and customized to the needs of the population and of their clients. When we see that there is a rise in Latinos, that means that the treatments and all the healthcare workforce needs to be adapted to manage these specific needs. That means in terms of language, but also in terms of culture and understanding how Latinos understand drug use, what are the main barriers, main challenges on getting help and what this help looks like for them. We need to adapt it to that.

First thing of all, provide services in Spanish. Second, take into consideration their culture, how can understand and provide the treatment in line with their needs. I think that's the most important thing. Work with people in the community, use community health workers that are coming from the same community to engage people in treatment. Something that we know is that Latino community face big barriers on accessing and retaining into behavioral health care. Mostly it's due to these, what we call intrinsic or internal barrier, that it's, "I want to handle these by my own. I don't think I need anyone external to help me."

This barrier effects around 64% of Latino immigrants that we interviewed in one of our studies. We know that the majority of Latinos think they can handle the problem on their own and we also know that this is explain and mediated in a big amount by mistrust on the behavioral health services and mistrust on the services that they will be provided. We need to tackle that.

Kai: Is the adaptation of the health system that you described that is needed, is that happening? Do you see that happening?

Irene: In this report that SAMSA released last year on opioid use in Latinos, there are several initiatives that are across the country. There's around 10 that are described there. There are initiatives but they are still, how can I say, they are just anecdotical. It's not a generalized intervention at all.

Kai: Irene Falgás Bagué is a psychiatrist and researcher at the Disparities Research Unit at Harvard Medical School. Irene, thanks for joining us.

Irene: Thank you.

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