Substance use disorder affects everyone, though underserved communities face an uphill challenge with accessing treatment and recovery resources to achieve prevention due to varying circumstances. Overdose Lifeline, in grant-aligned partnerships, offers multiple programs designed to increase access to training modules that make a difference in substance use disorder treatment. One of these programs, MACRO-B, started in targeted Indianapolis ZIP codes and has had a significant impact. So much so that the program is expanding into more counties across the state.
Understanding Barriers to Overdose Prevention
The opioid epidemic continues to impact individuals and families across Indiana, with Black communities facing unique challenges related to access, stigma, and prevention resources. While substance use disorder is a treatable health condition, many communities have historically had limited access to education, overdose prevention tools, and timely intervention.
In urban centers like Indianapolis, these barriers have contributed to rising overdose deaths, particularly as fentanyl has become more prevalent in the illicit drug supply.
Today, the response to the drug epidemic is framed as an “urgent public health issue,” according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Substance use disorders (SUDs) and addiction are considered health conditions; diseases that are preventable and can be treated. Recovery is also more accessible with the right services—though historically these services have not been readily available to Black communities.
Even when medically indicated, Black Americans are much less likely to be prescribed opioids for pain control.
Current Disparities in Opioid Addiction
Recent studies show that Black Americans are now more likely to die from opioid overdoses than other races. In 2020, opioid overdoses rose by 30% compared to the previous year. In this same period, the death rate among Black Americans increased by 44%, the most significant increase among all racial and ethnic groups. This trend has continued in more recent years. According to the CDC, rates of drug overdose deaths increased from 47.5 to 48.9 (deaths per 100,000).
What is Causing the Increase in Opioid Deaths?
There are several interconnected factors contributing to higher rates of opioid overdose deaths in Black communities. These include limited access to healthcare, biased treatment practices, and broader socioeconomic challenges that affect health outcomes.
A November 2024 Springer article showed that differences in access to overdose prevention interventions and treatment options have played a significant role in these disparities. The article highlights how important it is to recognize these differences as a key driver in substance use outcomes, and this understanding must be integrated into existing models of substance use disorder prevention, treatment, and research.
Community conditions also shape overdose risk. Stigma surrounding substance use disorder, mistrust of institutions, and concerns about legal consequences can discourage individuals from seeking overdose prevention services or support. These factors can delay care and reduce access to life-saving tools.
Another significant factor to call out with the rise of opioid overdose deaths is the prevalence of fentanyl, a much stronger opioid that is fatal in most cases. The limited access to overdose prevention tools and treatment services for SUDs compounds with the rise of fentanyl to create a dangerous environment for impacted communities.
The Opioid Situation in Indianapolis
Indianapolis, like many other urban centers, has seen a sharp uptick in opioid addiction and overdose deaths among its Black residents. The number of fentanyl-related overdose deaths increased from 195 in 2018 to 799 in 2021. In line with most data sources, fentanyl-related overdose deaths among Black residents increased from 19% of the total in 2016 to 29% in 2021, while they decreased from 79% to 70% for White counterparts for the same timeframe.
These trends highlight the importance of targeted education, community-based prevention strategies, and expanded access to naloxone (Narcan™).
The MACRO-B Project: Addressing Racial Disparities with Opioid Overdoses in Indianapolis
In response to all these challenges, Overdose Lifeline launched the MACRO-B (Multi-Sector And Multi-Level Community-Driven Approaches to Remove Structural Racism and Overdose Deaths in Black Indianapolis Communities) project together with Indiana University in October 2022. The project was backed by the U.S. Department of Health of Human Services and Office of Minority Health for three years, from October 2022 to September 2025. The funding was awarded to Dr. Dong-Chul Seo, Full Professor at the Indiana University School of Public Health-Bloomington.
The multi-year initiative aimed to reduce opioid overdose deaths in four of Indianapolis’s hardest-hit ZIP codes by identifying and removing the barriers and clearing the path for improved education around SUD treatments, and increasing access to overdose prevention tools like naloxone (Narcan™).
The MACRO-B project employs a comprehensive approach to tackle these racial disparities. Key strategies include:
- Research and data collection: Conducting surveys and interviews to identify barriers to treatment and develop targeted interventions.
- Naloxone distribution: Ensuring that naloxone, a life-saving medication that can reverse opioid overdoses, is readily available in Black communities.
- Educational programs: Providing culturally sensitive education and training on opioid use disorder and harm reduction practices.
- Community engagement: Partnering with local organizations and community leaders to build trust and increase awareness about opioid addiction and available resources.
After the first year, overdose deaths in the target ZIP codes decreased by 26.9 percent. By the conclusion of the three-year project, overdose deaths in these communities declined by 45 percent.
MACRO-B’s work is clearly working. The project had an initial goal to reduce overdose deaths in the target ZIP codes by 25% by September 2025. Instead, that goal was met and exceeded by the end of 2023 with a 26.9% reduction.
Expanding Impact Across Indiana
Building on the success in Marion County, Overdose Lifeline has received funding to expand MACRO-B training and resources to additional Indiana counties, including:
- Allen County
- Lake County
- Vanderburgh County
- St. Joseph/Elkhart County
- Delaware County
The success of the MACRO-B project demonstrates the impact of community-based education, partnership, and prevention. As Overdose Lifeline continues to expand this work across Indiana, the focus remains on equipping individuals with the knowledge, tools, and confidence to prevent overdoses and save lives. The progress made through MACRO-B reinforces a simple truth: reducing overdose deaths is possible when communities are equipped and supported.
For more information or to connect with the MACRO-B team, contact Charlotte or Claire at Overdose Lifeline.
Read More About MACRO-B on Their New Website
MACRO-B recently launched a new website covering the ‘why’ of the project, information on the joint Coalition, and showcasing their work and findings. The project will continue onward, with more naloxone kits distributed, more education and awareness driven in affected communities, and more pressure put on lawmakers to amend legislation to protect people carrying harm reduction tools and who call law enforcement to prevent opioid overdoses.
The opioid crisis has disproportionately affected Black communities for a long time, but MACRO-B is evidence of the power of grassroots efforts. It is not only possible to reduce the devastating harm of the opioid crisis, it is necessary.
