Beginning in 2019, there was a concerning surge in drug overdose fatalities, but in 2023, these numbers have shown a decrease, as reported by the Centers for Disease Control and Prevention. The majority of these deaths were linked to opioids. However, even with the decline, there are still pronounced racial disparities in opioid-related deaths, especially among Black individuals. This enduring issue is partly due to what many believe to be the subtle yet significant racially targeted influence of big pharmaceutical companies on the opioid crisis.

As these pharmaceutical companies settle lawsuits with various states and cities, the legal system has yet to fully acknowledge their role in worsening the opioid crisis within Black communities. It’s essential that the settlement funds be directed towards aiding these severely impacted communities.

A year ago, I was approached by a leading law firm in Manhattan to serve as an expert witness in a trial. My background as a sociologist who examines the racial dynamics of substance use was the reason for this request. The trial aimed to shed light on the pharmaceutical industry’s influence on the opioid epidemic. The firm was defending a major pharmaceutical company being sued by Baltimore for its part in the city’s severe opioid crisis.

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Over the past seven years, Baltimore has seen over 6,000 deaths due to illicit drug use, particularly opioids, with the highest death rates among older Black men. This rate is the most significant per capita in any major U.S. city. The defense strategy suggested by the law firm claimed that the crisis was not primarily due to pharmaceutical companies but rather complex issues like limited job opportunities and inadequate healthcare, which are products of deep-rooted systemic racism.

I found the defense argument somewhat questionable. Indeed, systemic problems have significantly contributed to the U.S.’s opioid crisis. However, if you look closely, it’s apparent that pharmaceutical companies might have exploited these societal weaknesses. Despite this, the impact on Black communities has barely been addressed in the national discussions about opioid settlements, where pharmaceutical giants have paid vast sums to state and local governments. These funds should ideally be reinvested into the communities most affected.

I eventually separated from the law firm several months before the trial without accepting any fees. Not surprisingly, their client settled with Baltimore but denied any wrongdoing. The company likely withdrew early to avoid a prolonged trial and the inevitable public scrutiny that would have followed exposure of their actions—or lack thereof—in the marginalized, low-income community.

When examining some national settlements, it’s clear that the funds are not specifically designated for the communities and groups most affected, such as Black communities. Often, these groups are underrepresented in decisions about how the funds should be allocated.

For instance, Ohio is set to receive up to $2 billion in settlement funds. Since 2017, Black men in Ohio have experienced the highest drug overdose death rates among all demographics. The state created the OneOhio Recovery Foundation, a nonprofit managed by local volunteers, to oversee these funds. However, a report from a local NPR station in September 2024 noted that only two of the 29 board members were Black.

Initially, during the early 2000s, opioid marketing primarily targeted white, affluent, and rural working-class communities. At that time, opioid prescription and misuse rates were significantly higher among white populations than Black ones. However, by the mid-2010s, as sales began to decline due to federal regulations, pharmaceutical companies shifted their marketing focus to racially diverse counties.

Within a few years, the disparity in prescription misuse rates between Black and white Americans had nearly disappeared. This shift occurred even though medical professionals have historically been more likely to underestimate Black patients’ pain and less likely to prescribe them opioids due to unfounded fears of misuse or resale. When people are denied access to these medications, they often turn to illicit and more dangerous drugs like heroin and fentanyl, which are cheaper and more potent but also more likely to cause an overdose. Nearly 80 percent of heroin users report starting with prescription opioids. Furthermore, studies show that treatments for opioid use, such as buprenorphine, are less accessible to Black individuals due to cost and availability of licensed providers.

The government’s failure to address these racially targeted tactics by big pharma mirrors past oversights. For example, in the 1970s, as federal authorities clamped down on tobacco marketing in white communities, companies like R.J. Reynolds Tobacco Company began aggressively marketing menthol cigarettes to Black consumers. Consequently, Black Americans now suffer from disproportionately high rates of smoking and smoking-related cancers. Although a multibillion-dollar settlement was reached in the 1990s to combat years of predatory tobacco advertising, a recent report shows that only a small fraction of these funds has been used for prevention and cessation efforts.

Of the roughly $50 billion earmarked from the nationwide opioid settlements over the past five years, states have received about $4 billion due to slow legal and governmental processes and uncertainty over fund allocation. The impact of these funds has so far been minimal, with overdose death rates remaining steady and racial disparities persisting. Early indicators suggest that the funds are being spent unevenly, ranging from essential resources like life-saving overdose reversal medications to less critical uses like police cars and surveillance equipment, which are remnants of the failed and racially biased war on drugs. These trends highlight the need for more strategic use of the opioid settlement funds.

Looking forward, settlement agreements must thoroughly consider racial disparities and ensure that government allocations from pharmaceutical lawsuits directly address the factors fueling the Black opioid epidemic. Research consistently indicates that lack of access to mental health treatment, often exacerbated by chronic exposure to racial stressors and discrimination, is a key contributor to opioid misuse in Black communities. Therefore, funds should also be directed towards enhancing culturally sensitive drug treatment programs and improving prescription monitoring to help prescribers identify potential misuse. This could significantly increase the chances that Black individuals seeking pain relief receive appropriate support and guidance, potentially preventing the transition from prescription opioids to more hazardous street drugs.

Moreover, more funding should be allocated to support community prevention initiatives, focusing on addressing the underlying causes and consequences of the Black opioid epidemic, such as neighborhood crime, mass incarceration, economic disinvestment, and urban decay. These factors increase the likelihood of opioid misuse among Black youth. The government should use settlement funds to specifically expand early childhood education and workforce development programs, subsidize new developments in vulnerable communities, and enhance neighborhood conditions.

While no amount of money can compensate for the lives lost to the opioid epidemic in cities like Baltimore, proactive allocation of settlement funds to address the factors that have intensified the crisis, including the role of big pharma, is crucial for reversing this entirely preventable catastrophe.

This is an opinion and analysis article, and the views expressed by the author or authors are not necessarily those of Scientific American.