Disparities in Substance Use and Overdose, and How Mobile Programs Can Help

Disparities in substance use and overdose describe the uneven distribution of overdose deaths and treatment access across racial, ethnic, and geographic groups. Overdose death rates are far higher among American Indian and Alaska Native and Black populations than the national average, and a recent national decline has reached some groups while bypassing others. In 2023, overdose death rates were highest among American Indian and Alaska Native people at 65.0 per 100,000 and Black people at 48.5 per 100,000. Mobile programs help by placing treatment inside the communities that fixed systems reach last, which narrows the access gap that drives much of the disparity. A behavioral health satellite clinic network is one way to do that.

The gap is widening, not closing, for some groups. From 1999 to 2022, overdose mortality rose most among Black Americans at 249.3%, Hispanic and Latino Americans at 171.8%, and Native Americans at 166.3%. Any program that aims to reduce overdose has to design for these differences rather than treat the population as uniform.

Which groups face the highest overdose rates?

American Indian and Alaska Native people and Black people face the highest overdose death rates in the United States. The gap between these groups and the national picture is large and persistent.

In 2023, the overdose death rate was 65.0 per 100,000 among American Indian and Alaska Native people and 48.5 per 100,000 among Black people. These figures sit well above the national average, and they reflect long-running differences in access, treatment, and structural conditions rather than differences in who uses drugs. Naming the most affected groups is the first step toward a program that reaches them.

Why is the recent national decline uneven?

The recent national decline in overdose deaths is uneven because it has not reached communities of color at the same pace, if at all. A falling national number can hide rising local ones.

In 2023, White people were the only group with a statistically significant decrease, and declines have been uneven, with rises continuing among people of color. A program that measures only the national trend will miss what is happening in the communities most at risk. Local, group-specific data should guide where a mobile unit goes and whom it serves.

What drives the disparities?

Disparities are driven largely by unequal access to treatment and by structural barriers, rather than by differences in substance use across groups. When effective treatment is available but out of reach, the result is higher mortality in the communities furthest from care.

The treatment access gap is wide across the whole population, and it falls hardest where care is scarce. Among adults who needed opioid use disorder treatment in 2022, only 25.1% received medications for opioid use disorder. That means about three in four people who needed the most effective treatment did not get it. Structural barriers, including distance, cost, transportation, and mistrust of institutions, concentrate that gap in communities of color and in rural areas. Effective medication exists: agonist medication such as methadone or buprenorphine is associated with roughly a 50% reduction in mortality among people with opioid use disorder. Closing the distance between that medication and the people who need it is the core problem.

How can mobile programs narrow the access gap?

Mobile programs narrow the access gap by bringing treatment directly into communities that fixed sites underserve, removing the distance and transportation barriers that keep people out of care. A unit parked at a trusted community location meets people where they are.

Program design choices that widen reach:

• Prioritize community engagement. Build relationships and partnerships with trusted groups. Listen to community leaders and let them guide key decisions.

• Site in the communities with the highest rates, guided by local, group-specific overdose data rather than the national trend.
• Offer medications for opioid use disorder on the unit, since that is the treatment most tied to lower mortality.
• Reduce friction with walk-in access, flexible hours, and same-day starts where possible.

Consistency drives trust, and trust drives return visits. Hire staff dedicated to the mobile program rather than rotating fixed-site clinicians onto the unit. Rotation breaks the community continuity these programs depend on, and it makes the mobile program the first service cut when a fixed site loses a clinician. Sound planning and staffing for the mobile program keeps the same team present in the community over time.

What does culturally responsive care look like?

Culturally responsive care looks like a program that reflects the community it serves, in its staff, its language, and its practices. People engage with care that respects who they are, and disengage from care that does not.

In practice this means hiring staff who share the community's language and lived experience, using person-first and non-stigmatizing language consistently, and building services around community norms rather than imposing a template. Terms like person who uses drugs and person with opioid use disorder, rather than stigmatizing labels, signal respect and keep people coming back. A behavioral health satellite clinic network can be staffed and operated with these choices built in from the start.

How do community and tribal partnerships strengthen a program?

Community and tribal partnerships strengthen a program by grounding it in local trust and local knowledge, which are exactly what fixed systems often lack in the hardest-hit areas. Given that American Indian and Alaska Native communities carry the highest overdose rates, tribal partnership is central rather than optional.

Partners help with siting, outreach, staffing, and the credibility that determines whether people show up. They also connect a program to local policy and funding conversations; the policy center can support that engagement. Partnership turns an outside program into a community resource, which is the difference between a unit that people avoid and one they use.

Frequently asked questions

Which racial and ethnic groups have the highest overdose death rates?

American Indian and Alaska Native people and Black people have the highest overdose death rates. In 2023, the rate was 65.0 per 100,000 among American Indian and Alaska Native people and 48.5 per 100,000 among Black people, both well above the national average. These gaps reflect unequal access and structural barriers rather than differences in substance use.

Are overdose deaths going down for everyone?

No. In 2023, White people were the only group with a statistically significant decrease, while deaths continued to rise among people of color. From 1999 to 2022, overdose mortality rose most among Black, Hispanic and Latino, and Native Americans. A falling national number can hide rising rates in specific communities.

Why do disparities in overdose exist?

Disparities are driven largely by unequal access to treatment and by structural barriers such as distance, cost, transportation, and mistrust of institutions. Effective medication exists and is associated with roughly a 50% reduction in mortality, but among adults who needed opioid use disorder treatment in 2022, only 25.1% received it. The gap concentrates in communities of color and rural areas.

How does a mobile program help reduce these disparities?

A mobile program brings treatment, including medications for opioid use disorder, directly into communities that fixed sites underserve, removing distance and transportation barriers. Sited using local overdose data and staffed by a dedicated team that reflects the community, it builds the trust that sustains care. Community and tribal partnerships strengthen its reach and credibility.

If you serve a community carrying a disproportionate overdose burden and want to bring treatment closer to the people who need it, see how a behavioral health satellite clinic network can be sited, staffed, and operated to narrow the access gap.