‘A forgotten generation’: Older Black men in Boston are dying of drug overdoses at alarming rates
A new analysis shows that they are now hardest hit by the opioid epidemic
By Chris Serres and Yoohyun Jung
Updated January 30, 2025, 5:00 a.m.
Anthony James is the first to admit that for most of his adult life, he lived under the illusion that he was invincible.
He was just 14 and attending South Boston High School when he was attacked by a mob of white students during the city’s busing crisis. A few years later, he took his first euphoric hit of cocaine, which sent him down a decades-long spiral of addiction that frequently put him in harm’s way. Seared into his memory is the metallic click-click of a drug dealer’s gun pointed at his head.
Yet his faith in his own resilience was shattered just before Christmas, when he smoked a vial of cocaine that, unbeknownst to him, was laced with amphetamines and fentanyl — a powerful synthetic opioid that is deadly even in tiny amounts. Immediately, he began to hear hallucinatory voices and felt an anxiety so severe that he felt like killing himself.
“It felt like I was already dead,” James, 61, said.
James is among the fortunate ones.
The deadly opioid scourge that has long been perceived as an epidemic that started largely in white communities has evolved into something else: a crisis among Black men, who are now suffering in far greater numbers from the increasingly potent mix of cocaine and fentanyl hitting the streets. Even as deaths are falling sharply among white people, they are skyrocketing among Black men — particularly the middle-aged and elderly, according to a Globe analysis of death records.
Statewide, the rate of deadly overdoses among Black men over 55 soared 242 percent between 2017 and 2023, while overall, the rate for men of all races declined over the same period, state Department of Public Health data show. In Boston, middle-aged and elderly Black men are overdosing at rates dramatically higher than any other demographic group.
“It should be our number one public health priority,” said Deirdre Calvert, director of the state Department of Public Health’s Bureau of Substance Addiction Services. “I don’t think that there’s a more important subject matter or discussion that we should be having than the overdose death rates among Black populations, and specifically older Black men.”
Yet the systems designed to treat addiction have not kept pace with this rapid shift in the racial dynamics of the opioid crisis. Many Black men in addiction recovery programs in Boston said they feel unwelcome in programs that are largely designed by white people and run by them. Too often, they find themselves surrounded by people who cannot relate to their experiences and past trauma, say treatment specialists, therapists, and Black people in addiction recovery.
What has become increasingly clear is that a deadly opioid epidemic born in rural and suburban America is now devastating communities of color in large cities — and Black men are now bearing the brunt of the epidemic.
An investigation into millions of death records — through a partnership including the Globe, The New York Times, The Baltimore Banner, Stanford University’s Big Local News, and eight other newsrooms — identified dozens of cities where overdose death rates are unusually high among Black men born from 1951 to 1970.
In cities including Baltimore, Chicago, Philadelphia, and San Francisco, deaths among this cohort of older black men (now between 54 and 73) are higher than for any other group — just as they have been for much of the past three decades, the analysis found.
This disparity was not as pronounced in Boston until more recently. Previously,Black men of this generation died of overdoses at similar rates to all men until the fentanyl crisis.
But in 2022, the most recent year with national data, this generation of Black men died at rates more than four times the average in Suffolk County, and more than eight times the national average. The Globe’s review of Massachusetts data showed that trend has continued.In 2023, Black men in this generation, age 54 to 73, died from overdoses at more than four times their share of the population, according to a Globe analysis of death certificate data.
The immediate driver is fentanyl, which is cheap to produce and is increasingly being laced into cocaine — the drug of choice for many Black men struggling with addiction. In Suffolk County, 77 percent of the Black men who died of overdoses in 2023 had cocaine in their systems, often in combination with fentanyl, compared with 52 percent of white men, according to a Globe analysis of death records.
State health officials acknowledged they need to do more to reverse the trend, and they are tapping more of the multibillion-dollar settlements with the opioid industry for their role in the epidemic by flooding the nation with highly addictive painkillers. Over the past three years, $22.8 million of the $207 million received by the state through opioid settlements has been invested in equity-focused initiatives, including efforts to target harm reduction strategies at communities of color that are at high risk of overdoses and programs that diversify the ranks of those who work in addiction treatment.
Yet the deadly toll reflects decades of financial insecurity, the legacy of the 1980s war on drugs, and longstanding barriers to treatment.
Black men born between 1951 and 1970 came of age at a time when harm reduction strategies were in their infancy, when crack cocaine was king, and the solution to the problem was largely punitive. Studies have found that the criminalization of drug use made it less likely for this generation to seek treatment — a legacy that still persists, according to health researchers and addiction treatment specialists.
“For too long, a blind eye has been turned toward our community,” said Lovelee Harvey, 55, a former cocaine user and senior recovery coach with Metro Boston Alive, a nonprofit recovery center in Boston’s Roxbury neighborhood. “We are a forgotten generation.”
In interviews, Black men in addiction recovery describe feeling alienated in programs that are not designed for them and their particular drugs of choice. The overwhelming focus is on opioids, such as prescription painkillers and heroin, and not on cocaine — a stimulant — with a range of different side effects. In Suffolk County, the vast majority of people enrolled in substance use addiction services over the past five years were white.
Even today, Black people who use cocaine face a legacy of discrimination that dates back to the war on drugs.
Many sober homes and treatment programs in Greater Boston require drug users to first complete a detoxification program to prove they are sober. Yet detox programs often won’t admit people whose primary drug is cocaine because the withdrawal symptoms are perceived as less severe. In interviews, Black men in recovery said they sometimes have to hide their cocaine use, or even take heroin, simply to be admitted to a detox center, often a first step on the road to recovery.
“The disparities reflect the fact that we’ve medicalized opioid use disorder and have not medicalized stimulant use disorder,” said Miriam Komaromy, medical director of Boston Medical Center’s Grayken Center for Addiction. “We still treat the use of cocaine and methamphetamine as . . . optional for people as if they’re making a bad choice, whereas we recognize that with opioid use disorder, their behavior is often entirely out of their control.”
In interviews, many Black men in addiction recovery described feeling unwelcome at treatment programs and support group meetings in Boston, which tend to be run by white people for people struggling with opioid use. James recounted several experiences of racism in treatment programs, including an incident in which a white patient threw a chair at him and called him a racial slur. Others said they felt uncomfortable opening up about their past trauma and experiences using drugs with white treatment specialists.
Eric Henderson, 39, a musical artist from Dorchester who goes by the name Exit Fame, lost his father to a drug overdose in 2011 and has spent the past five years in recovery from his own cocaine addiction.
“Say you’re coming from Dorchester, Roxbury, or Mattapan, and all of a sudden you’ve got some kid who just graduated college telling you what to do who’s never walked where you’ve walked,” said Henderson, who now works as a recovery coach with the Gavin Foundation, a Boston addiction services provider. “You are not going to open up in those types of spaces.”
There are also cultural differences in the approaches to addiction. Many in the Black community object to what they see as an overly tolerant attitude toward drug use among white therapists and recovery coaches. Moreover, many Black individuals in recovery object to programs that hand out drug needles to users or tolerate frequent relapses. “It’s very difficult to stay sober when the person next to you is using,” said Stephanie Jackson-Wilson, who owns and operates a sober home in Mattapan. “A lot of us in the Black community come from a place of abstinence.”
On a bright January afternoon, Harvey and two other outreach workers with Metro Boston Alive gathered beneath a woven portrait of Marcus Garvey, the revolutionary Jamaican leader who inspired Malcolm X and pushed for the unity of Black people. Amid jovial banter, they filled blue tote bags with boxes of the overdose-reversal drug Narcan and special strips for testing whether street drugs contain fentanyl, among other supplies.
Within moments after arriving at Roxbury’s Nubian Square, a small crowd of Black men — some homeless and familiar to the group as longtime drug users — surrounded the outreach squad. The blue bags were quickly gone.
“You gotta go back! Go back to treatment!” Harvey exhorted an old friend, Eric French, 59, who looked unsteady and admitted to a recent relapse. “If you fall off that horse 99 times, you gotta get up 100 times!”
As they circled Nubian Square on foot, talk among the group turned to a familiar topic: what was ailing older men in the predominantly Black neighborhood. Some had been taking cocaine for decades while holding jobs and remaining active in the community, they said. But that changed dramatically a few years ago when fentanyl and other toxic substances started showing up in the illicit drug supply; and even casual cocaine use became deadly.
“When the fentanyl came in here, it destroyed everything,” said Shanna Johnson, a volunteer member of the outreach team and the community engagement coordinator with Codman Square Health Center in Dorchester. “I tell people now, `You may not be looking for fentanyl, but fentanyl is definitely looking for you.’ ”
Yet the odds that a Black resident of Boston will be offered treatment — even after surviving a life-threatening overdose — are slim compared to their white counterparts, research studies have shown. A 2019 analysis by the Boston Public Health Commission found that only 10 percent of Black patients in Boston who were hospitalized for an overdose accessed substance use treatment within 30 days. That compared with 26 percent of white people who suffered overdoses, the analysis found.
In another survey of 59 Boston overdose survivors, published last spring, several Black and Latino participants reported that “no one discussed treatment or service options” immediately after they overdosed. In contrast, no white participants described this experience. “People need to recognize how damaging that is, when treatment is not even offered” after someone suffers a life-threatening overdose, said Ranjani Paradise, director of evaluation at the Malden-based Institute for Community Health, which led the survey.
James said his recent experience with fentanyl-laced cocaine was “a giant wake-up call,” and he’s resolved to stay clean. Since the incident in December, he returned to a sober home in Mattapan and landed a full-time job as a cook at the Pine Street homeless shelter, where two months ago he took his last dose of cocaine. He’s also found solace in his faith, dropping to his knees on his hardwood floors each morning to pray.
On a recent Sunday morning, James was upbeat — blaring gospel music from his smartphone — as he strolled down the snowy sidewalk to Morning Star Baptist Church in Mattapan. Tears poured down his face as the church’s pastor, Bishop John Borders, recounted the miracle in the Bible of Aaron’s staff, which blossomed and bore almonds as a symbol of God’s power and judgment.
“God can turn your life around in 24 hours!” thundered Borders from the pulpit, amid cheers and shouts of “Amen!”
Then, as the congregation dispersed, James waited patiently with a Bible tucked under his arm for a moment alone with the pastor.
Heads bowed and hands clenched, the two men prayed for the strength to stay sober.
