36 UnitedStates TheEconomistApril9th 2022
cal director of opioidpolicy research at
Brandeis University, describes some of
these victims as survivors of the heroin
epidemic that devastated inner cities in
the 1960s and 70s. Unaware that a more po
werful synthetic opioid had contaminated
their supply, “older black men who man
aged to beat the odds and survive for de
cades started dying,” explains Dr Kolodny.
George (not his real name), a 55year
old West Baltimore native, has struggled
with addiction since he was a teenager. In
the four decades since he was first handed
powdered heroin wrapped in a dollar bill
the landscape has changed: “You used to be
able to get a quality bag of heroin. Now you
have this synthetic drug out here on the
streets everywhere.” He now uses fentanyl
regularly and estimates he has overdosed
on it four times in the past couple of years.
“When you’re messing with this stuff,
everything’s a blur,” he says. “I don’t know
how I keep outliving people, but I really
don’t want to leave this Earth an addict.”
The poison has crept into stimulants,
too. Overdose deaths attributed to psycho
stimulants used with opioids have risen.
Some are referring to this as a fourth wave
of the epidemic. For those unaccustomed
to opioids or “speedballing” (mixing stim
ulants with opioids), fentanyl is “a shock to
the system, shutting down your breathing
and heart rate”, says Keith Humphreys, a
professor of psychiatry at Stanford Univer
sity. Some 35% of AfricanAmericans who
died of overdoses in 2020 had both cocaine
and fentanyl in their system, compared
with 16% of white victims.
Poor people are more than twice as like
ly to die of opioid overdose. Onefifth of Af
ricanAmericans live in poverty. Fully 40%
of all homeless people and 38% of prison
ers are black (compared with just 13% of the
overall population). These are all potent
risk factors. And though an estimated 65%
of America’s prisoners suffer from a sub
stanceuse disorder of some sort, there is
little access to good treatment either dur
ing incarceration or upon release.
Treatment for oudis woefully inadequate across the country, but African
Americans often face extra barriers. Stud
ies have found that medications for treat
ing oud,as well as naloxone (a lifesaving
medication that reverses opioid overdos
es), are doled out unevenly. A study of data
from Medicaid, the government insurance
programme for the poor, across several
states with some of the highest opioid
overdose rates found that between 2014and 2018 blackpeoplewithoudwere28%
lesslikelytouseoudmedications.
Studiesinvariouscities,includingSan
FranciscoandLosAngeles,suggestthatAf
ricanAmericanshavelessaccesstonalox
one,too.InDetroitbetween 2019 and2020,
whiteaddictsreceived28%ofnaloxonead
ministrations,thoughtheyaccountedfor
17% of the city’s opioid overdoses; al
though 80% of overdoses were among
blackpeople,theyreceivedonly 67%of
naloxoneadministrations.Thisdoesnot
necessarilymeanblackaddictsarebeing
deniednaloxone.Thosewhouseopioids
alone,arehomelessorliveincommunities
withlittletrustinfirstrespondersmight
belesslikelytocallforhelp.
Suchdisparitiesstrengthenthecasefor
local interventions that deal with the un
ique hurdles certain communities face.
Other solutions are more sweeping, like
expanding access to Medicaid and reduc
ing red tape around oudmedications. But
underlying all these is a straightforward
calculus that applies to all Americans,
black or white: “It has to beeasierto get
treated than it is to continueusing,” says
Dr Kolodny. “You have to flip it.”nPattern of abuse
United States, lethal opioid overdoses per 100,000 peopleSource:CentresforDiseaseControlandPrevention *Age-adjusted †Incl.AlaskaNatives‡Hispanicofany race §Incl. Pacific IslandersAgerangeByrace*White Black6040200
15-24 25-34 35-44 45-54 55-64 65-7422, age distribution by race
3020100
2000 20151005Black
WhiteHispanic‡American Indian†Asian§D
riveanywhereinNewJerseyand
you will almost certainly see a bump
er sticker or a car magnet bragging that
“Jersey girls don’t pump gas”. For 73
years, New Jerseyans have relied on
petrolstation attendants to fill their cars
and lorries, rather than do it themselves.
It is a point of pride for many to say they
do not know how to pump petrol, as
much a part of local identity as pork rolls
or salt water taffy at the Jersey shore.
Might the Garden State join the other
49 and allow drivers to serve themselves?
A combination of record fuel prices and a
shortage of pump attendants means that
changing the 1949 law is gaining sup
port—including from the owners of the
state’s petrol stations, who have histori
cally opposed any reform. In the past
highschool and college students were
happy to take on attendant jobs, which
require a day’s apprenticeship. But now
Ebbie Ashabi, who owns two stations
and delivers petrol to more than 50 oth
ers, says, “We cannot find people.”
Some station operators are paying $17
an hour, $4 more than the state’s mini
mum wage, and still are shortstaffed.
They have no choice but to shut down
pumps for hours at a time, causing long
queues at the ones that remain open. YetmostNewJerseyanslikethestatus
quo. A recent Rutgers University poll
showed that 73% do not want to pump
petrol themselves. Some have antiquated
notions about pumping being danger
ous. Declan O’Scanlon, a state lawmaker
who supports the reform, points out
that: “It is absolutely true, Jersey girls are
hotter than girls anywhere else. It is not
true that they are more flammable.”
This reform would still leave the state
with the most stringent fullservice
requirements in America. “We are pro
posing giving the consumer a choice,”
says Sal Risalvato, head of an association
representing New Jersey petrol stations.
It would save 15 cents a gallon, he notes.
Phil Murphy, the governor, has called
fullservice “part of our fabric” and
changing it “a political third rail in New
Jersey”. Nicholas Scutari, president of the
state Senate, is currently blocking the
measure, but has said that if public senti
ment changed, or if data showed that it
would dramatically reduce costs, he
would reconsider. Most New Jerseyans,
pragmatic and sceptical by nature, would
agree, says Micah Rasmussen of the
Rebovich Institute for New Jersey Poli
tics, at Rider University. “We’re not giv
ing away something for nothing.”FillingyourtankinNewJerseyTo pump or not to pump?
F RANKLIN LAKES, NEW JERSEY
That is the question in the only state that still bans self-service petrol stations