When Latoya Jenkins talks about her mom, she likes to focus on happy memories like the games she used to play with her kids.
"She used to buy two bottles of dish soap," Jenkins said. "One bottle was for the dishes. The other bottle was for rainy days. She would take us outside and we would make bubbles."
Jenkins, who lives in upstate New York, says her mom, Sonya Hughey, had a hard life, first using crack cocaine when she was a teenager.
The loneliness and isolation of the pandemic made Hughey's substance use disorder worse. She was using methamphetamines and in November she was arrested.
According to Jenkins, her mother tried to get help. "She asked, you know? Can I get the rehab? I have a drug problem. They said no. Rehab wasn't an option for her."
In December, Hughey who was 48 years old used methamphetamines contaminated with the deadly synthetic opioid fentanyl. "We got a phone call from my mom's boyfriend that he found her dead," Jenkins said.
Scientists at the Centers for Disease Control and Prevention say fatal drug overdoses nationwide have surged roughly 20% during the pandemic, killing more than 83,000 people in 2020.
While the CDC doesn't track overdose deaths by race, a growing body of research suggests Black Americans have suffered the heaviest toll.
A deadly collision of race, addiction and COVID-19
"It wasn't until we started looking at the level of race and ethnicity that we realized Black and brown communities are being disproportionately affected," said Dr. Utsha Khatri, a researcher at the University of Pennsylvania.
Khatri's team analyzed drug overdose data collected in Philadelphia during the pandemic. They found overdose deaths surged more than 50% among the city's Black residents.
Among whites, by contrast, drug overdose fatalities remained flat and in some months even declined.
"COVID really just acted as salt in the wounds of health and social inequities, perpetuated by structural racism both in Philadelphia and across the country," Khatri said.
Her findings were published January in a peer-reviewed study in the Journal of the American Medical Association. This added to a growing sense of alarm among researchers and public health officials.
"The COVID-19 pandemic has sharply exacerbated the inequities of the overdose crisis, which is really, really scary," said Dr. Ayana Jordan, a researcher at Yale University.
Jordan is part of a team analyzing overdose data collected in California during the pandemic.
She said preliminary findings show "really concerning" racial disparities, with Black overdose deaths rising significantly faster than among whites.
Academics, public health officials and addiction treatment experts interviewed by NPR said these indicators are deeply troubling but not surprising.
Even before the pandemic, studies showed overdose rates in Black communities rising much faster than among whites.
Racial legacy of "drug war" policies that left "treatment deserts"
In part, the trend reflects the spread of fentanyl, a toxic synthetic opioid that contaminates street drugs sold illegally in the U.S.
But critics also blame America's drug war, which shaped what many experts describe as a two-track system for people experiencing addiction.
For whites and those who are financially well-off, substance use disorder is often treated as a chronic but survivable illness. That means long-term health care and life-saving medications.
By contrast, people of color and poor Americans who experience addiction regularly face arrest and incarceration, while rarely gaining access to high-quality healthcare.
"We're still seeing punitive measures, harsh measures happening in those minority communities, and there's a lack of rehabilitative facilities," said Jasmine Drake, a former Drug Enforcement Administration researcher who teaches at Texas Southern University.
Last week, the American Society of Addiction Medicine released a policy statement condemning "systemic racism in drug policy and addiction medicine" and demanding reforms.
Dr. Stephen Taylor, who co-authored the ASAM report, said too often people of color with addiction are viewed as "the prototype of a criminal."
"Arrests and incarceration, that's the way it was dealt with," Taylor said. "That's what's been in place for a long time, and I don't see that we've made progress in that."
Addiction experts describe "treatment deserts" in many Black communities, where high-quality, affordable rehab programs are scarce or nonexistent.
Often it's even difficult to find basic life-saving drugs like Naloxone, an easily-administered medication that reverses opioid overdoses.
A recovery system where Black Americans feel unwelcome
When Black Americans do find their way into drug treatment, critics say they frequently find programs that don't match the reality of their lives.
"I get so angry because I'll get referrals from clinics where people have been dismissed [from treatment] because they didn't make it to their appointment on time," said Yale's Ayana Jordan.
"I say well, did you think about whether the person was coming from work? Or the bus was running late? All of these things have to be considered, especially if there are child care issues."
Dr. Nzinga Harrison, who runs a nationwide, Black-owned drug rehab network called Eleanor Health, said people of color who find treatment also face racial bias and stigma from care providers, who are often white.
"You can hear it in the tone. You can see it when you're waiting in line and a person who's not Black comes in and they address that person before they address you," she says.
Harrison said the degree of racial bias in addiction care was shown starkly by a study published in 2019 in the Journal of the American Medical Association.
It showed Black patients with opioid use disorder were 35 times less likely than whites to be prescribed Buprenorphine, another medication considered highly effective in preventing relapses and fatal overdoses.
"These experiences add up time and time and time and time to say this system does not have my best interests at heart," Harrison said.
A peer-reviewed JAMA study published last month found overdose deaths in urban communities could be reduced by as much as 40% within two years.
But researchers acknowledge saving those lives would require sweeping changes, including much wider access to drug-treatment medications as well as long-term care designed to keep people in recovery.
Latoya Jenkins believes that kind of help might have made all the difference for her mother. "If they would have listened to her pleas for treatment, I feel strongly that she would be alive right now," she said.
Jenkins said people in her family who still struggle with addiction and face high risk of overdose don't believe they'll get that kind of care.
"They have that fear. If you go to get help, then people want to turn you in ... and have your children taken away. If they are seen somewhere using drugs, instead of, 'Hey can I get you to a treatment center or get someone to help you. No, we're going to throw you in jail,'" Jenkins said.
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