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05-11-2024 | Opioids | REVIEW

Addressing Racial and Ethnic Inequities in Opioid Overdose Mortality: Strategies for Equitable Interventions and Structural Change

Authors: Fabiola Arbelo Cruz, Oluwole Jegede

Published in: Current Psychiatry Reports

Abstract

Purpose of Review

This review synthetizes findings reflecting the increasing racial and ethnic inequities in opioid overdose mortality and emphasizes the necessity for tailored interventions as well as other policy-level and structural strategies to stem this trend.

Recent Findings

Factors contributing to inequities in overdose mortality include changes in drug supply, persistent social-structural vulnerabilities stemming from structural racism, and inequities in access to medication for opioid use disorder and harm reduction services. Key strategies to address these inequities include the cultural adaptation of evidence-based interventions within an equity-based framework, integrating social determinants of health into addiction treatment, centering anti-racism praxis in addiction research, diversifying the addiction workforce, and integrating structural competency as a tool to restructure education and inform practice.

Summary

Structural racism must be recognized as a key driver of inequities in substance use outcomes, and this understanding must be integrated into existing models of substance use disorder prevention, treatment, and research.

We have selected to use the term Latine in this article with the acknowledgment that it is a gender-inclusive term, refers to people with heritage from Latin America and not Spain, and is more accepted and used throughout the Spanish-speaking community. We also acknowledge that Latine people may identify more strongly with their nation of origin or other panethnic terms.

Tsai B. U.S. Overdose Deaths Decrease in 2023, First Time Since 2018. National Center for Health Statistics: CDC; 2024.

Friedman JR, Nguemeni Tiako MJ, Hansen H. Understanding and Addressing Widening Racial Inequalities in Drug Overdose. Am J Psychiatry. 2024;181(5):381–90. https://doi.org/10.1176/appi.ajp.20230917.CrossRefPubMed

Ciccarone D. The rise of illicit fentanyls, stimulants and the fourth wave of the opioid overdose crisis. Curr Opin Psychiatry. 2021;34(4):344–50. https://doi.org/10.1097/YCO.0000000000000717.CrossRefPubMedPubMedCentral

Gibbons JB, Harris SJ, Solomon KT, Sugarman O, Hardy C, Saloner B. Increasing overdose deaths among Black Americans: a review of the literature. Lancet Psychiatry. 2023;10(9):719–26. https://doi.org/10.1016/S2215-0366(23)00119-0.CrossRefPubMed

Dasgupta N, Beletsky L, Ciccarone D. Opioid Crisis: No Easy Fix to Its Social and Economic Determinants. Am J Public Health. 2018;108(2):182–6. https://doi.org/10.2105/AJPH.2017.304187.CrossRefPubMedPubMedCentral

Park JN, Rouhani S, Beletsky L, Vincent L, Saloner B, Sherman SG. Situating the Continuum of Overdose Risk in the Social Determinants of Health: A New Conceptual Framework. Milbank Q. 2020;98(3):700–46. https://doi.org/10.1111/1468-0009.12470.CrossRefPubMedPubMedCentral

van Draanen J, Tsang C, Mitra S, Karamouzian M, Richardson L. Socioeconomic marginalization and opioid-related overdose: A systematic review. Drug Alcohol Depend. 2020;214:108127. https://doi.org/10.1016/j.drugalcdep.2020.108127.CrossRefPubMedPubMedCentral

Jegede O, Bellamy C, Jordan A. Systemic Racism as a Determinant of Health Inequities for People With Substance Use Disorder. JAMA Psychiat. 2024;81(3):225–6. https://doi.org/10.1001/jamapsychiatry.2023.4958.CrossRef

Barnett ML, Meara E, Lewinson T, Hardy B, Chyn D, Onsando M, et al. Racial Inequality in Receipt of Medications for Opioid Use Disorder. N Engl J Med. 2023;388(19):1779–89. https://doi.org/10.1056/NEJMsa2212412.CrossRefPubMedPubMedCentral

10.

Kilaru AS, Xiong A, Lowenstein M, Meisel ZF, Perrone J, Khatri U, et al. Incidence of Treatment for Opioid Use Disorder Following Nonfatal Overdose in Commercially Insured Patients. JAMA Netw Open. 2020;3(5):e205852. https://doi.org/10.1001/jamanetworkopen.2020.5852.CrossRefPubMedPubMedCentral

11.

Landis RK, Levin JS, Saloner B, Gordon AJ, Dick AW, Sherry TB, et al. Sociodemographic differences in quality of treatment to Medicaid enrollees receiving buprenorphine. Subst Abus. 2022;43(1):1057–71. https://doi.org/10.1080/08897077.2022.2060424.CrossRefPubMedPubMedCentral

12.

Zang X, Walley AY, Chatterjee A, Kimmel SD, Morgan JR, Murphy SM, et al. Changes to opioid overdose deaths and community naloxone access among Black, Hispanic and White people from 2016 to 2021 with the onset of the COVID-19 pandemic: An interrupted time-series analysis in Massachusetts. USA Addiction. 2023;118(12):2413–23. https://doi.org/10.1111/add.16324.CrossRefPubMed

13.

Dayton L, Tobin K, Falade-Nwulia O, Davey-Rothwell M, Al-Tayyib A, Saleem H, et al. Racial Disparities in Overdose Prevention among People Who Inject Drugs. J Urban Health. 2020;97(6):823–30. https://doi.org/10.1007/s11524-020-00439-5.CrossRefPubMedPubMedCentral

14.

Shim RS. Dismantling Structural Racism in Psychiatry: A Path to Mental Health Equity. Am J Psychiatry. 2021;178(7):592–8. https://doi.org/10.1176/appi.ajp.2021.21060558.CrossRefPubMed

15.

Friedman J, Hansen H, Bluthenthal RN, Harawa N, Jordan A, Beletsky L. Growing racial/ethnic disparities in overdose mortality before and during the COVID-19 pandemic in California. Prev Med. 2021;153:106845. https://doi.org/10.1016/j.ypmed.2021.106845.CrossRefPubMedPubMedCentral

16.

Friedman JR, Hansen H. Evaluation of Increases in Drug Overdose Mortality Rates in the US by Race and Ethnicity Before and During the COVID-19 Pandemic. JAMA Psychiat. 2022;79(4):379–81. https://doi.org/10.1001/jamapsychiatry.2022.0004.CrossRef

17.

Friedman J, Kim D, Schneberk T, Bourgois P, Shin M, Celious A, et al. Assessment of Racial/Ethnic and Income Disparities in the Prescription of Opioids and Other Controlled Medications in California. JAMA Intern Med. 2019;179(4):469–76. https://doi.org/10.1001/jamainternmed.2018.6721.CrossRefPubMedPubMedCentral

18.

Hoffman KM, Trawalter S, Axt JR, Oliver MN. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci U S A. 2016;113(16):4296–301. https://doi.org/10.1073/pnas.1516047113.CrossRefPubMedPubMedCentral

19.

League CU. Whitewashed: The African American Opioid Epidemic. Research and Policy Center. 2017.

20.

Friedman J, Hansen H, Gone JP. Deaths of despair and Indigenous data genocide. Lancet. 2023;401(10379):874–6. https://doi.org/10.1016/S0140-6736(22)02404-7.CrossRefPubMed

21.

Cano M, Gelpí-Acosta C. Variation in US drug overdose mortality within and between Hispanic/Latine subgroups: A disaggregation of national data. SSM - Mental Health. 2022;2:100095. https://doi.org/10.1016/j.ssmmh.2022.100095.CrossRef

22.

Phelan JC, Link BG. Is Racism a Fundamental Cause of Inequalities in Health? Annual Review of Sociology. 2015;41(2015):311-30. https://doi.org/10.1146/annurev-soc-073014-112305.

23.

van Draanen J, Jamula R, Karamouzian M, Mitra S, Richardson L. Pathways connecting socioeconomic marginalization and overdose: A qualitative narrative synthesis. Int J Drug Policy. 2023;113:103971. https://doi.org/10.1016/j.drugpo.2023.103971.CrossRefPubMed

24.

Bowleg L. Reframing Mass Incarceration as a Social-Structural Driver of Health Inequity. Am J Public Health. 2020;110(S1):S11–2. https://doi.org/10.2105/AJPH.2019.305464.CrossRefPubMedPubMedCentral

25.

Wildeman C, Wang EA. Mass incarceration, public health, and widening inequality in the USA. Lancet. 2017;389(10077):1464–74. https://doi.org/10.1016/S0140-6736(17)30259-3.CrossRefPubMed

26.

Arbelo Cruz F. At Risk Populations: People of Color. Reference Module in Neuroscience and Biobehavioral Psychology. Elsevier; 2023.

27.

Mital S, Wolff J, Carroll JJ. The relationship between incarceration history and overdose in North America: A scoping review of the evidence. Drug Alcohol Depend. 2020;213:108088. https://doi.org/10.1016/j.drugalcdep.2020.108088.CrossRefPubMedPubMedCentral

28.

Binswanger IA, Stern MF, Deyo RA, Heagerty PJ, Cheadle A, Elmore JG, et al. Release from prison–a high risk of death for former inmates. N Engl J Med. 2007;356(2):157–65. https://doi.org/10.1056/NEJMsa064115.CrossRefPubMedPubMedCentral

29.

Merrall EL, Kariminia A, Binswanger IA, Hobbs MS, Farrell M, Marsden J, et al. Meta-analysis of drug-related deaths soon after release from prison. Addiction. 2010;105(9):1545–54. https://doi.org/10.1111/j.1360-0443.2010.02990.x.CrossRefPubMedPubMedCentral

30.

Arbelo Cruz FC, D.; Durham, M. Racial Inequities in Treatment of Addictive Disorders. American Academy of Addiction Psychiatry Newsletter. 2021;37:10; 20–1.

31.

Husain JM, Cromartie D, Fitzelle-Jones E, Brochier A, Borba CPC, Montalvo C. A qualitative analysis of barriers to opioid agonist treatment for racial/ethnic minoritized populations. J Subst Abuse Treat. 2023;144:108918. https://doi.org/10.1016/j.jsat.2022.108918.CrossRefPubMed

32.

Key Substance Use and Mental Health Indicators in the United States: Results from the 2022 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration; 2023.

33.

Heimer R, Black AC, Lin H, Grau LE, Fiellin DA, Howell BA, et al. Receipt of opioid use disorder treatments prior to fatal overdoses and comparison to no treatment in Connecticut, 2016–17. Drug Alcohol Depend. 2024;254:111040. https://doi.org/10.1016/j.drugalcdep.2023.111040.CrossRefPubMed

34.

Kariisa M, Davis NL, Kumar S, Seth P, Mattson CL, Chowdhury F, et al. Vital Signs: Drug Overdose Deaths, by Selected Sociodemographic and Social Determinants of Health Characteristics - 25 States and the District of Columbia, 2019–2020. MMWR Morb Mortal Wkly Rep. 2022;71(29):940–7. https://doi.org/10.15585/mmwr.mm7129e2.CrossRefPubMedPubMedCentral

35.

Chambers LC, Hallowell BD, Zullo AR, Paiva TJ, Berk J, Gaither R, et al. Buprenorphine Dose and Time to Discontinuation Among Patients With Opioid Use Disorder in the Era of Fentanyl. JAMA Netw Open. 2023;6(9):e2334540. https://doi.org/10.1001/jamanetworkopen.2023.34540.CrossRefPubMedPubMedCentral

36.

Lei F, Lofwall MR, McAninch J, Adatorwovor R, Slade E, Freeman PR, et al. Higher First 30-Day Dose of Buprenorphine for Opioid Use Disorder Treatment Is Associated With Decreased Mortality. J Addict Med. 2024;18(3):319–26. https://doi.org/10.1097/ADM.0000000000001300.CrossRefPubMed

37.

Jordan A, Quainoo S, Nich C, Babuscio TA, Funaro MC, Carroll KM. Racial and ethnic differences in alcohol, cannabis, and illicit substance use treatment: a systematic review and narrative synthesis of studies done in the USA. Lancet Psychiatry. 2022;9(8):660–75. https://doi.org/10.1016/S2215-0366(22)00160-2.CrossRefPubMed

38.

Saloner B, Le Cook B. Blacks and Hispanics are less likely than whites to complete addiction treatment, largely due to socioeconomic factors. Health Aff (Millwood). 2013;32(1):135–45. https://doi.org/10.1377/hlthaff.2011.0983.CrossRefPubMed

39.

Rosales R, Janssen T, Yermash J, Yap KR, Ball EL, Hartzler B, et al. Persons from racial and ethnic minority groups receiving medication for opioid use disorder experienced increased difficulty accessing harm reduction services during COVID-19. J Subst Abuse Treat. 2022;132:108648. https://doi.org/10.1016/j.jsat.2021.108648.CrossRefPubMed

40.

Nelson A. Unequal treatment: confronting racial and ethnic disparities in health care. J Natl Med Assoc. 2002;94(8):666–8.PubMedPubMedCentral

41.

Blanco C, Wiley TRA, Lloyd JJ, Lopez MF, Volkow ND. America’s opioid crisis: the need for an integrated public health approach. Transl Psychiatry. 2020;10(1):167. https://doi.org/10.1038/s41398-020-0847-1.CrossRefPubMedPubMedCentral

42.

Perera C, Salamanca-Sanabria A, Caballero-Bernal J, Feldman L, Hansen M, Bird M, et al. No implementation without cultural adaptation: a process for culturally adapting low-intensity psychological interventions in humanitarian settings. Confl Health. 2020;14:46. https://doi.org/10.1186/s13031-020-00290-0.CrossRefPubMedPubMedCentral

43.

Castro FG, Barrera M Jr, Holleran Steiker LK. Issues and challenges in the design of culturally adapted evidence-based interventions. Annu Rev Clin Psychol. 2010;6:213–39. https://doi.org/10.1146/annurev-clinpsy-033109-132032.CrossRefPubMedPubMedCentral

44.

Huey SJ Jr, Tilley JL, Jones EO, Smith CA. The contribution of cultural competence to evidence-based care for ethnically diverse populations. Annu Rev Clin Psychol. 2014;10:305–38. https://doi.org/10.1146/annurev-clinpsy-032813-153729.CrossRefPubMed

45.

Whaley AL, Davis KE. Cultural competence and evidence-based practice in mental health services: a complementary perspective. Am Psychol. 2007;62(6):563–74. https://doi.org/10.1037/0003-066X.62.6.563.CrossRefPubMed

46.

Bernal G, Jiménez-Chafey MI, Domenech Rodríguez MM. Cultural adaptation of treatments: A resource for considering culture in evidence-based practice. Prof Psychol Res Pract. 2009;40(4):361–8. https://doi.org/10.1037/a0016401.CrossRef

47.

Jordan A, Costa M, Nich C, Swarbrick M, Babuscio T, Wyatt J, et al. Breaking through social determinants of health: Results from a feasibility study of Imani Breakthrough, a community developed substance use intervention for Black and Latinx people. J Subst Use Addict Treat. 2023;153:209057. https://doi.org/10.1016/j.josat.2023.209057.CrossRefPubMed

48.

Bellamy CD, Costa M, Wyatt J, Mathis M, Sloan A, Budge M, et al. A collaborative culturally-centered and community-driven faith-based opioid recovery initiative: the Imani Breakthrough project. Soc Work Ment Health. 2021;19(6):558–67. https://doi.org/10.1080/15332985.2021.1930329.CrossRef

49.

Pamplin JR, Rouhani S, Davis CS, King C, Townsend TN. Persistent Criminalization and Structural Racism in US Drug Policy: The Case of Overdose Good Samaritan Laws. Am J Public Health. 2023;113(S1):S43–8. https://doi.org/10.2105/ajph.2022.307037.CrossRefPubMedPubMedCentral

50.

Jegede O, Nunes JC, Tumenta T, Black C, DeAquino JP. What Would Equitable Harm Reduction Look Like? AMA J Ethics. 2024;26(7):E572–9. https://doi.org/10.1001/amajethics.2024.572.CrossRefPubMed

51.

Gainsbury SM. Cultural Competence in the Treatment of Addictions: Theory Practice and Evidence. Clin Psychol Psychother. 2017;24(4):987–1001. https://doi.org/10.1002/cpp.2062.CrossRefPubMed

52.

Jordan A, Jegede O. Building Outreach and Diversity in the Field of Addictions. Am J Addict. 2020;29(5):413–7. https://doi.org/10.1111/ajad.13097.CrossRefPubMed

53.

Fletcher FE, Jiang W, Best AL. Antiracist Praxis in Public Health: A Call for Ethical Reflections. Hastings Cent Rep. 2021;51(2):6–9. https://doi.org/10.1002/hast.1240.CrossRefPubMedPubMedCentral

54.

Ford CL, Airhihenbuwa CO. Critical Race Theory, race equity, and public health: toward antiracism praxis. Am J Public Health. 2010;100(Suppl 1):S30-5. https://doi.org/10.2105/AJPH.2009.171058.CrossRefPubMedPubMedCentral

55.

Came H, Griffith D. Tackling racism as a “wicked” public health problem: Enabling allies in anti-racism praxis. Soc Sci Med. 2018;199:181–8. https://doi.org/10.1016/j.socscimed.2017.03.028.CrossRefPubMed

56.

Metzl JM, Hansen H. Structural competency: theorizing a new medical engagement with stigma and inequality. Soc Sci Med. 2014;103:126–33. https://doi.org/10.1016/j.socscimed.2013.06.032.CrossRefPubMedPubMedCentral

Title: Addressing Racial and Ethnic Inequities in Opioid Overdose Mortality: Strategies for Equitable Interventions and Structural Change
Authors: Fabiola Arbelo Cruz
Oluwole Jegede
Publication date: 05-11-2024
Publisher: Springer US
Keywords: Opioids
Opioids
Addiction
Addiction
Published in: Current Psychiatry Reports
Print ISSN: 1523-3812
Electronic ISSN: 1535-1645
DOI: https://doi.org/10.1007/s11920-024-01556-7

Keynote series | Spotlight on menopause

Springer Medicine

Addressing Racial and Ethnic Inequities in Opioid Overdose Mortality: Strategies for Equitable Interventions and Structural Change

Abstract

Purpose of Review

Recent Findings

Summary

Keynote series | Spotlight on menopause

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

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