Executive director/co-founder Soma Snakeoil helps a client at the pick out clothing and food at the Sidewalk Project's day center on Skid Row. (Ural Garrett/AfroLA)

Opioid addiction recovery providers favor individual-centered treatment options for Black women

This is the first story in a solutions-reported series that explores new approaches to addiction recovery programs for Black women. Each story looks at the issue from a different perspective including local healthcare providers former clients. (Read the second and third stories here.)

The criminalization and stigmatization of opioid addiction and treatment in the Black community is well-documented. A December 2022 study found Black women have lost nearly 750,000 years of life to opioids since 2015, emphasizing the critical need for improved treatment options for Black women as deaths continue to climb. Some addiction treatment programs in Los Angeles are crafting new approaches to care. 

The Sidewalk Project, an arts and harm-reduction organization that assists unhoused people on Skid Row, treats their clients in whatever way they arrive to receive care, said Regina Speights, a nurse practitioner specializing in psychiatry. She worked with the Sidewalk Project as part of her doctoral research using screening tools for PTSD and the impact the tools have on motivation.

Speights said consistency and empathy were the biggest lessons she learned working with women on Skid Row. She organized the distribution of ethnic hair care products for Black women, along with regular medical services, hygiene kits and harm reduction devices like oil burners and straight shooters, safe smoking and sterile injection equipment. 

“We don’t think about things like having a comb that can actually comb through your hair, having a conditioner that could really condition your hair. And, African American women, we have hips, so I take underwear that can accommodate larger hips, “ Speights said. “I loved on those women.”

For Speights, her work and that of the Sidewalk Project has always been about meeting Black women—and anyone on the street—with what they need in that moment, no strings attached. 

“It doesn’t matter how much melanin is in your skin. If you are coming to us, you need help. We are going to give that woman whatever we have to help her heal and help her get the services she needs,” Speights said. But, providing for Black women on the streets can be challenging because of mental, emotional and physical traumas.

“Sometimes in the African American community,” said Speights, “there’s the ‘what goes on in this house, stays in this house’ mentality. And, I believe that’s one of the most traumatic things within our communities.”  Many of the women she helped using her research project tool scored positive for PTSD and other undiagnosed mental health disorders that stemmed from unspoken physical and mental abuse. 

“Sometimes when I would screen these women, they would just start talking to me. And, when I heard about the sexual abuse, the physical abuse-–-where are they supposed to go? I mean, what happens when you have little girls who are abused, and then they grow up to be women, but they never got any assistance?” Speights posited. “The schools failed them, the community failed them, because there was a lack of resources, [and] there still is a lack of resources in our communities.” 

Client-centered care

Friendly House, an addiction treatment center in Los Angeles, uses a client-based approach which requires women to formulate a treatment plan based on their personal circumstances and goals. Christina Simos, director of Friendly House, said there’s an extra layer of ‘Can I trust you?’ that must be broken down before many clients are willing to accept help, and it’s reliant upon having the right support.

“Having gone through this house, I understand what it’s like to feel hopeless, powerless, lost and unsure about the future or the present,” said Simos, a former Friendly House resident who has been sober for 17 years “For me, the community piece was instrumental in breaking the stigma, the shame and the pain of returning back to [my]self.” Today, she tries to ensure clients have a “brave space to connect in” and are able to see others like them who have “made it to the other side.” “They have to see, feel and understand that recovery is possible,” Simos said. 

Simos said that although she was able to find a program that helped her kick drugs and alcohol, she knows  other Black women like her don’t always have the same opportunities, or even the mental energy to seek help. With that in mind, she explained, the racial trauma and cultural stigmas that make people reticent to get help need to be addressed.

When Black women “don’t take [their] business outside,” they often miss critical chances to get assistance for mental health and substance abuse issues, Simos said. They’ve been taught to “override” any problems they may face.

More resources available for a growing, multifaceted problem 

Since 2015, deaths from opioids—which include prescription painkiller fentanyl, heroin, and methadone—-have skyrocketed among Black men and women. Opioid deaths of Black men in their 30s and 40s are projected to rise 11% by 2025. Research from the Centers for Disease Control and Prevention found racial disparities in opioid treatment contributed to a 44% increase in opioid deaths among Black people from 2019-2020. According to a report from the Substance Abuse and Mental Health Services Administration on overdose rates in the Black community,  social and political coverage on the human impact of the opioid crisis have focused on white men, only including Black and Indigenous men in recent years.

In a March 2020 interview with the Pew Charitable Trust, addiction expert Dr. Scott Nolen said  “the number one way to improve access to treatment” is to make treatment services available with few requirements to use them and in places where low-income, homeless and food insecure people can actually reach them. Nolen, former director of the Addiction and Health Equity Program at the Open Society Institute of Baltimore, said that reducing barriers, like cost, travel time, insurance pre-authorizations, fear of incarceration or fear of losing public benefits for housing, food and employment because of a relapse or treatment program requirements, is part of accessibility. 

In a recent interview with AfroLA, Nolen added that, in his experience, the confluence of anti-Blackness, anti-poverty and anti-substance abuser mentalities in the criminal justice system seep into the medical system and result in biases for clinicians and EMTs that prevent them from treating those in need effectively. 

“There’s an overarching culture that is so ‘anti’ various elements of who these folks are, that there’s a barrier to get into the type of help that they might otherwise get if they were living in a different community or if they had a different sort of demographic profile,” Nolen said.

 A January report from the Commonwealth Fund, an independent health care research foundation centered on equity, predicts dire consequences for the Black community. Researchers said “legal settlements with drug manufacturers and others accused of fueling the opioid crisis” Like Nolen, the report supports “building ‘‘non-arrest’ pathways to drug treatment and recovery” and investing in supporting resources like transitional housing to improve outcomes for opioid addiction in marginalized communities.

“When I was working, we had a situation where the police took a woman and dumped her out of the ER, because they didn’t want to deal with her. Even with limited capacity and limited staffing, that’s no excuse for putting people out in the cold when they need medical care,” Nolen said. 

Since 2018, ERs have begun to provide doses of buprenorphine to patients going through withdrawal rather than sending them home. But, to Nolen, there are still better ways to prevent the medical system from “offloading these folks.”

For him, the solution comes in the form of community-based harm reduction centers, which are staffed with people from the community who may have similar experiences to those seeking recovery. Nolen said, they also have more flexibility than a legal and criminal justice system that focuses on whether or not someone is using. 

Instead, explained Nolen, harm reduction centers hone in on clients’ personal goals: “Your goal might be to stop using, but it might not be; your goal might be to use less.” “When you honor what people want, people want to live well, they want to do something that is [worth] achieving,” he said. 

But, harm reduction centers in cities and low-income areas are often subject to the same biases and stigmas that criminalize opioid use for their clients. Dr. Rebecca Trotzky-Sirr, an L.A.-based psychology and behavioral health specialist, said it’s her job to ensure quality health services are delivered to clients, requiring competency, familiarity and comfort delivering addiction treatments, services that include housing and food support and addressing behavioral health needs, as well as administration of opioid treatments like buprenorphine and naloxone.  “Getting to that point is a big structural challenge. And even within that dyad between patient and provider, there’s a lot of implicit and explicit biases that come into play,” Trotzky-Sirr said. 

“Historically, we as a society have looked at addiction as a bad behavior, as a criminal choice, rather than a chronic disease that has excellent treatment,” said Trotsky-Sirr. “So, the shift in mental models have to happen both at the social level, with my community, with my patients, their families, and also with my [fellow] health care providers. I’m always questioning my own intrinsic biases about that, too,” she said. 

Care that breaks down barriers and bias

Despite challenges and biases, Trotzky-Sirr said she strives to address the multifaceted nature of addiction care, even if the patient is not primarily coming in to treat their addiction. Trotzky-Sirr said she helps patients with addiction whether they’re having addiction issues, and it is brought to her attention by her patient, or she learns about their addiction through other means, like a pregnancy test or diabetes checkup. 

Sometimes, even when prompted with screening questions, patients are “very successful” at hiding indicators of their addiction if they’re “not ready” to deal with it yet. “It’s about creating a safe space…and telling our community members that we offer these services,” said Trotzky-Sirr. “Each time I treat somebody for opioid use disorder, I say, ‘Hey, tell your friends, tell your boyfriend, tell your kids,’ you know. Tell everybody that we’re able to do this, because that word of mouth is just as important as everything else.”

While resources are being talked about more and more, providing a physical safe space for recovery is not without its challenges. “It’s simple. We are dealing with systemic racism. In order to keep people where they are, resources are limited to those that ‘have,’” said Simos. “Those that don’t ‘have’ receive substandard care in many cases, making treatment or recovery less desirable.” Historically-excluded communities have resources like methadone clinics that are more widespread, but methadone isn’t as effective a treatment option for opiate use as buprenorphine. “Drugs were brought into our communities to keep us from evolving and then criminalized to break our family systems,” she said. This was true in the 1960s when Civil Rights leaders talked about it and it’s still “relevant” today, Simos continued. 

Black women continue to be disproportionately harmed by opioid abuse, and by treatment centers, according to Trotzky-Sirr. “[Centers] were well-intentioned,” she said. Many of the policy changes being made by the Los Angeles Health Department include more explicit practices around informed consent for drug testing, the role drug tests, and what happens if you test positive. “We’re much more mindful of the structural biases in place,” Trotsky said. 

“When women recover,” Simos said, “the world recovers.”

For opioid addiction treatment services in Los Angeles County, contact the County Substance Abuse Hotline: 323-804-7500. For additional information on addiction assistance in Black communities, visit SAFE Project.

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