Edward Waters has been dealing with pain all his life.
He has sickle cell anemia, an inherited condition that causes blood cells that are usually round and flexible to take a crescent moon shape. Those cells don’t pass through the veins easily and block oxygen to areas of the body, causing severe pain.
Waters' pain was controlled by opioids doctors prescribed: OxyContin and oxycodone. Sometimes the pain would be so rough he was admitted to the hospital for intravenous treatment.
But in 1997, things changed. In a way, Waters took his pain management into his own hands.
“One day, I was with another brother that had sickle cell anemia and he was doing heroin. And he was like, 'Hey man, instead of taking all those pills for pain controls, you can do this, brother, and it’s cheaper. 'It’s easier to obtain, man, and it will help you with your pain management better,'” Waters said.
The heroin worked. It relieved his pain and he began relying on the drug for pain management. Waters was able to use heroin for years without loved ones being able to detect he was using it. He didn’t have marks on his arms like other heroin users.
Waters said he would empty eye drop bottles and fill them with a heroin solution. He could then discreetly snort the drug when he needed it.
“That was a device to use the heroin instead of shooting it in my arms or putting it on tin foil and smoking it. I just snorted it," Waters said. "And it helped give me pain control.”
It took some time before Waters realized how reliant he was on those couple of squirts.
“I thought I was having a sickle cell crisis and I told my friend, 'Man, call 911. I’m sick man. My sickle cell has never hurt this bad,'" he said. "He said, 'Man, you ain’t going through no sickle cell attack, Eddy, that’s heroin. You withdrawing.'"
Waters said he took a hit of heroin and everything was fine.
"That’s when I knew I was an addict,” he said.
Waters said staying “well” is a lot of painstaking work.
He said being "well" is a common slang term among users. “That means I ain’t got no dope, but I ain’t sick. After a while, you stop using it to get high. You just use it to stay well.”
Waters, who is black, eventually turned to selling heroin. His addiction has caused him a lot of physical pain and dismantled his family. He has spent multiple stints in jail.
Waters' story as it relates to pain is similar to many opioid pain patients. He thought he had his drug use under control, but he didn’t and he became an addict. His use of painkillers led to heroin.
But very little has been said about African Americans and Latinos amid the opioid crisis. Last fall, President Donald Trump declared the opioid crisis a public health emergency and said, "Nobody has seen anything like what's going on now."
Narratives of white executives, politicians and their children grappling with opioid abuse have grabbed the attention and sympathy of the public and the government. Millions of dollars have been spent to aid the epidemic.
The current crisis is often compared to the crack cocaine epidemic of the 1980s that ravished the black community. The drug in crystallized form was popular in communities of color, and it carried heftier criminal charges than the powder that was more commonly used by whites.
Crack led to the death and incarceration of millions of people of color, even though the two forms of cocaine were essentially the same drug.
The truth is, America has seen an opioid crisis before. In the 1960s and 70s, soldiers returned from Vietnam addicted to heroin and the drug circulated through impoverished inner-city communities through drug lords like Frank Lucas, who was depicted in the 2007 film "American Gangster." Lucas smuggled heroin into the country in the caskets of dead soldiers from Vietnam.
“He flooded the streets of the East Coast like you never seen before,” said Michael Braxton, the executive director and founder of the nonprofit Empowerment Clinic. “My uncle was one of the fatalities. My mother actually found my uncle dead on the couch with a needle in his arm from overdosing.
Braxton said the country didn't declare a national health crisis at that time "because it was only affecting black people."
Braxton is a former substance abuser himself, and has been clean for over a decade. He started the clinic to provide services to disadvantaged populations; African Americans, Latinos and the LGBT community. Empowerment Clinic offers transitional housing, mental health, substance abuse and life improvement services. They have three locations in the greater Portland area.
“Fast forward to the epidemic now of opiates again, black people are left out of the discussion. But when we look at our client base and we see 40 percent of our clients in treatment for opiate addiction, they don’t get talked about. Their stories aren’t important because they're not the doctor's son or the politician's daughter. They're just poor black people, so it doesn’t become important.”
Braxton said services and recommended treatments aren’t necessarily even safe and reliable for people of color.
“If you go on the Oregon Health Authority website and you look at evidence based practices and you look at the control groups that they use, I think less than 5 percent of the individuals were identified as black or Latino," he said. "The reality is we don’t even know if this works for African Americans or Latinos.”
Last year, Empowerment served 600 patients. Dr. Camilia Kent, the medical director at the Empowerment Clinic, said she finds it hard to believe people think the crisis is not impacting people of color because they don’t use opioids.
“That’s absolutely not true because my patient population is mainly people of color and they are predominately affected by this opioid crisis," Kent said.
She said there aren't many treatment options like Empowerment Clinic available to people of color.
Kent describes patients coming to the clinic feeling like they are not heard or treated fairly at other clinics. Some patients have even been misdiagnosed.
One of the most common treatments for opioids is methadone, a medication-assisted treatment that is used to taper people off opioid dependence.
The problem is, according to Kent, methadone “also predisposes that person to increased risk of heart attacks, increased risk of liver failure, kidney failure." Those are conditions black people already have a predisposition for, she said.
In order for people to even get the drugs, they have to stand in line.
“These people who are in the methadone lines, they have to go everyday. It almost takes two years to be able to take your own supply home,” Kent said. “So, it's almost two years that this person can’t get a job.”
Experts say the odds are stacked against people of color on the road to recovery. Still, Waters is trying to rebuild his life. Heroin lead him to prison. He’s served his time. He’s clean and he’s got plans.
“I’m just here to try to better myself. You know, I want to open up a flagging business this time and get another construction business going so I have to jump through some hoops to be certified again,” Waters said. “But it's going to take place. It's going to happen.”
Sharing America: A Public Radio Collaboration
Erica Morrison is part of the public radio collaborative “Sharing America,” covering the intersection of race, identity and culture. This new initiative, funded by the Corporation for Public Broadcasting, includes reporters in the Northwest and Hartford, Connecticut, St. Louis and Kansas City. You can find more "Sharing America" coverage here.
Opioid Crisis: The Ripple Effect
OPB’s coverage explores addiction management in prison, doctors and how they prescribe opioids, the use of cannabis in lieu of opioids for pain management, opioid addiction and black Portlanders, living outside with addiction, the crisis in rural Oregon and the use of virtual reality technology as a pain management method.
Part 1: VR Gives Oregon Patients AndDoctors An Alternative To Opioids
Part 2: How Oregon Bucked National Trends And Reduced Opioid Deaths
Part 3: Patients Embrace Medical Cannabis As Opioid Alternative — Without Guidance
Part 4: Communities Of Color Struggling But Ignored In The Opioid Crisis
Part 5: How The Opioid Crisis Could Lead To More Cases Of Liver Cancer In Oregon
Part 6: There's A Cure For Hepatitis C, But Oregon Limits Access