How the Mental Health Treatment Gap & Systemic Racism Affecting African Americans Contributed to George Floyd’s Death

National Mental Health Awareness Month 2021 | How the Mental Health Treatment Gap & Systemic Racism Affecting African Americans Contributed to George Floyd’s Death

George Floyd had lived with substance use disorder for four years before he was killed during an encounter with the police last spring in Minneapolis. His addiction began when he was prescribed opioids to control chronic pain.1 From there, his journey took him through the cycles of abstinence, relapse, and overdose at least once. On that tragic day in May 2020 during George Floyd’s now infamous encounter with former Minneapolis Police Office Derek Chauvin, the officer was heard to say, “I think he’s on something.”1 Toxicology reports would later reveal that Floyd did have fentanyl and methamphetamine in his system, but did that justify the inhumane treatment he received during the encounter, which resulted in his murder? In striking contrast to his experience, during her testimony, Floyd’s girlfriend, Courtney Ross recounted her own journey of addiction to opioids and shared how they both tried many times, unsuccessfully, to break the cycle of addiction. Ross, who is white, was treated on the witness stand with compassion and empathy by Derek Chauvin’s attorney who during the trial attempted to vilify Mr. Floyd and blame him for his own death after more than nine minutes under Chauvin’s knee. 

As the mother of 2 adult sons, I had very mixed emotions about watching the video that gripped the entire nation, causing a range of emotions from shock and sadness to outrage. Once I made the decision to watch it, the nine minutes felt like an eternity. As an African American physician assistant and physician assistant educator, I am painfully aware of how many people in our country stigmatize individuals with opioid use disorder. The stigma is typically far worse for people of color who suffer from this disorder. It was clear that Mr. Floyd was seen by the police officers on the scene as “less than human” and not worthy of the compassion that might have been afforded to someone who was not African American. 

George Floyd was one of 2.3 million African Americans suffering from opioid use disorder and among the 87% overall who are unable to access treatment.2 Additionally, there is a treatment gap for those with substance use disorder and mental illness, including depression. Floyd was likely in this group as well. He had lost his job because of the COVID 19 pandemic and was unable to care for his family, which most likely contributed to his use of opioids as it has for 1.1 million others in the United States.2 

In the closing remarks of the trial made on April 19, 2021, Special Prosecutor Jerry Blackwell said, “The truth of the matter is that the reason George Floyd is dead is because Chauvin’s heart was too small.” Yes, Floyd died from a lack of compassion; systemic and individual racism are rooted in a lack of compassion.1 African Americans are frequently stigmatized by their minoritized status, particularly in the presence of a substance use disorder. George Floyd might be alive today if not for the existence of systemic racism and the disparities and gaps in care that are prevalent in the African American community. What if Chauvin and his fellow officers had a peer navigation system of care available to them on that fateful day? Once Chauvin suspected Floyd “was on something,” instead of restraining him with a knee on his neck, a community health worker able to effectively communicate with someone with opioid addiction should have been available. Or the escalating situation might have been due to more than a lack of resources and personnel. Perhaps Chauvin and the other officers at the scene were desensitized by the negative images of African Americans with SUD. Could this be what triggered Chauvin’s decision to apply such harsh treatment and punishment to Floyd in that moment? 

I believe it is clearly time to critically examine the disparities in access to treatment for the African American and other communities of color, which can partially be tied to unequal messaging and a lack of SUD prevention efforts in those communities. In the 2020 report on the “Opioid Crisis in the African American Community,” a “key informant” is quoted as saying “…easily uncoupled from disinvestment in our communities, mass incarceration, over-policing, over-traumatizing…when the messages are devoid of the context, [they are] not effective and it feels naïve for the folks that are living it.”2 This emphasizes the importance that prevention messaging to communities of color be culturally sensitive and communicated by those grounded in cultural humility. 

The research clearly indicates that lack of access to culturally competent care, including prevention, harm reduction, and treatment, is contributing to the increasing overdose death rates among African Americans.2,3 Access to treatment is largely based on race, socioeconomic status, insurance coverage, and geography. Multiple studies suggest that African Americans have limited or no access to medication assisted treatment (MAT) when compared to their white counterparts.2 An augmented workforce that includes physician assistants could expand access to MAT and support to those struggling with opioid use disorder. The Physician Assistant Education Association has taken the lead in educating PA students with its PRAC-ED curriculum and ORN-2 Clinical Sites Initiative. Training an enhanced workforce with graduate PAs closing the gap in the field of addiction medicine is consistent with the goals of the current Administration. It has issued a drug policy priorities statement that addresses professional shortages in the field of addiction medicine and highlights “hiring diverse practitioners who reflect the cultures they serve” as an important workforce issue.3   

Could George Floyd’s life have been saved? If we consider the structural and systemic disparities in our country regarding race and ethnicity that lead to gaps in mental health treatment, the answer is yes.  The stigma, poor access to care, and over-criminalization of African Americans suffering from SUD contributed to his death. Yes, Derek Chauvin’s “heart was too small,” but as a country, we all need to search our individual hearts as we continue to grapple with the inequity and inequality that plague this nation. As overdose deaths claim the lives of thousands each year — and the criminal justice system claims many more — we must look at our own humanity and make every effort to stop the loss of precious human resources to this chronic disease. 


  1. Silva C. (2021, April 5). George Floyd’s addiction could change how we talk about drug use and Black Americans. USA Today. 
  3. Executive Office of the President. (2021). The Biden-Harris Administration’s Statement of Drug Policy Priorities for Year One.