From the forthcoming New Yorker ... "A Reporter at Large: The Addicts Next Door — West Virginia has the highest overdose death rate in the country. Locals are fighting to save their neighbors — and their towns —from destruction," by Margaret Talbot:
Half of those who began using heroin before 1980 were white; nearly ninety per cent of those who began using in the past decade were white. This demographic shift may be connected to prescribing patterns. A 2012 study by a University of Pennsylvania researcher found that black patients were thirty-four per cent less likely than white patients to be prescribed opioids for such chronic conditions as back pain and migraines, and fourteen per cent less likely to receive such prescriptions after surgery or traumatic injury.
But a larger factor, it seems, was the despair of white people in struggling small towns. Judith Feinberg, a professor at West Virginia University who studies drug addiction, described opioids as "the ultimate escape drugs."