Overdose Lifeline for Equity and Justice

Authors: Keeley Fischer, Lauryn Johnson, Alli Nickel, Dana Pflugradt


Overdose Lifeline has recognized that most people requesting naloxone, an opioid overdose reversal medication, are white. Other programs have also found that the medication is more often given to white people than black, African American, Latino, or Hispanic individuals (Kinnard et al., 2021).

            Opioid use and overdose have a profound impact on individuals, communities, and populations and their abilities to participate in daily activities. Naloxone promotes and advocates for increased life involvement and inclusivity within marginalized communities. When stripped of access to naloxone, a person is stripped of basic needs, roles, routines, opportunities, resources, and social participation. To stop this from happening at a racially disproportionate level, we need to engage in our communities and learn about racism, its impacts, and how to combat it.

            After acknowledging racial injustices, Overdose Lifeline has collaborated with occupational therapy students from Indiana University to evaluate ways to create equitable access to naloxone and a more just community. Occupational therapy can assist in regaining meaningful daily activities for individuals, groups, and populations, and an occupational therapy lens was utilized throughout this collaboration. The ongoing goal is to allow all individuals to participate in meaningful life activities throughout Indiana. By providing naloxone to anyone, Indiana can reduce the rate of deaths caused by opioid overdose. This change starts with you learning about the systemic racism that occurs in our country.

Inequalities in Criminal Justice

More black and Hispanic individuals are imprisoned for drug charges when compared to the overall US population [see chart in handout] (Carson, 2015; United States Census Bureau, 2020). Black men specifically are twice as likely to be given a mandatory minimum sentence, further demonstrating the inequalities (Starr & Rehavi, 2013). Racism is ingrained in United States’ history, from legalized slavery and segregation to higher rates of incarceration in communities of color.

One period to note was between 1986 and 2010 when there was significantly different sentencing for crack cocaine versus powder cocaine. The sentencing disparity is often called the 100:1 ratio since holding 5 grams of crack had a 5-year minimum sentence, and 500 grams of powder led to the same punishment (The Sentencing Project, 2010). Most individuals on trial for crack possession were black or African American, while most convicted for powder possession were white. Additionally, crack is no more addictive than cocaine, the two drugs are chemically identical, and they have similar effects on the body, all of which demonstrate that there is no justifiable reason for the difference in sentencing (The Sentencing Project, 2010). Black or African American individuals were serving, and continue to serve, much longer sentences than white individuals even though they were convicted for using an almost identical drug. In 2010, the Fair Sentencing Act was passed, which reduced the ratio from 100:1 to 18:1 (Lynch, 2021). However, there is hope. A bill, called Eliminating a Quantifiably Unjust Application of the Law, may soon be passed to end the disparities (Lynch, 2021).

Inequalities in Healthcare

Inequalities in healthcare exist regarding the treatment of different races. These disparities were exacerbated by the pandemic, given that there was a 9.7% increase in emergency room visits after overdose, with the majority of individuals identifying as black or African American (Patel et al., 2021). Even though most of those seeking help were black, they were also more likely to die from an overdose, possibly because of the faults in the patient-provider relationship (Maina et. al, 2018; Patel et al., 2021). This literature supports the power of understanding the attitudes and perceptions of race that surrounds healthcare access.

Moving Forward

The injustices mentioned rightfully amplify the mistrust that communities of color have in institutions dominated by white individuals. This is why we would like you to take a closer look at yourselves, who you support, and take any action you can to make a difference. We have provided a list of starting points and especially encourage you to take the Implicit Association Test. This test will allow you to look at what biases you may have. Knowing your prejudices will help you be more aware of how you treat others, and together, we can take steps to move toward a more just and equal society.

Instructions for taking the Implicit Association Test:

  1. Follow this link:
  2. Click “I wish to proceed”
  3. Select “Race IAT” (it’s the seventh blue button from the top)
  4. Select continue
  5. Read the questions and respond as honestly as possible.


Carson, E. A. (2015, September). Prisoners in 2014 – Bureau of Justice Statistics (Report No. NCJ 248955). Bureau of Justice Statistics.

Drug Policy Alliance (2015, June). The Drug War, Mass Incarceration, and Race [White paper].United Nations Office on Drugs and Crime.

Kinnard, E. N., Bluthenthal, R. N., Kral, A. H., Wenger, L. D., & Lambdin, B. H. (2021, 2021/08/01/). The naloxone delivery cascade: Identifying disparities in access to naloxone among people who inject drugs in Los Angeles and San Francisco, CA. Drug and Alcohol Dependence, 225, 108759.

Lynch, S. N. (2021, September 28). U.S. House passes bill to end disparities in crack cocaine sentences. Reuters.

Maina, I. W., Belton, T. D., Ginzberg, S., Singh, A. & T. J. Johnson. (2018). A decade of studying implicit racial/ethnic bias in healthcare providers using the implicit association test. Social Science & Medicine, 199, 219-229.

Patel, I., Walter, L. A., & Li, L. (2021). Opioid overdose crises during the COVID-19 pandemic: implication of health disparities. Harm Reduction Journal, 18(1), 1–5. 

The Sentencing Project (2010). Federal crack cocaine sentencing [White paper].

Starr, S. B. & Rehavi, M. M. (2013). Mandatory sentencing and racial disparity: Assessing the role of prosecutors and the effects of Booker. The Yale Law Journal, 123(1).

United States Census Bureau (2020). Quick facts: United States.

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