An Evaluation of Opioid Use in Black Communities: A Rapid Review of the Literature

Abstract

Background There are multiple aspects of the opioid crisis among Black people, who have been left out of the broader conversation. Despite evidence of increased opioid overdose deaths, less is known about opioid use among Black people. This review synthesizes research on Black people who use opioids; the goals are to advance knowledge, highlight research gaps, and inform clinical practice. Methods This rapid review investigating opioid use among Black people utilized systematic review methods and was conducted according to a predefined protocol with clear inclusion criteria (PROSPERO ID: 177071). A comprehensive search strategy was used, including published and gray-literature sources (i.e., literature that has not been formally published). A narrative summary of the results is presented. Results A total of 76 works were selected for inclusion and full text review. Sex, age, geographic location, and involvement in the carceral system were associated with the use of opioids among Black individuals. Non-epidemiologic factors included treatment-seeking patterns, disparate clinician prescribing, and social determinants. Conclusions Through this rapid review we suggest three main areas of focus: (1) including culturally informed collection methods in epidemiologic surveys to accurately reflect prevalences, (2) funding research that specifically addresses the importance of culture in accessing treatment, and (3) directly studying how social determinants can improve or exacerbate health outcomes. Focusing on the unique needs of Black people who use opioids is warranted to increase treatment initiation and adherence among a population less likely to engage with the traditional health care system.

The Epidemiology of Drug Abuse

“…Despite similar rates of substance use in pregnancy, Black women may be 10 times more likely to be reported to child protective services and poor women may also be more likely to be reported. Black patients may be less likely to receive treatment for opioid use disorder in primary care settings and generally have lower odds of completion of treatment 27 . In the correctional system, medication for opioid use disorder is an infrequent treatment consideration; former inmates possess an almost 13‐fold increased risk of death compared to demographic matches in the first 2 weeks after release 28 .…”

Racial/ethnic equity in substance use treatment research: the way forward

“…Gaps also remain in research aimed at understanding unique issues related to treatment, such as interventions to overcome current barriers to early treatment entry, interventions to prevent lower treatment completion, and advantages of culturally adapted versions, including modifications to overcome any adverse impact of social determinants of health on substance use treatment outcomes. An example of this is outlined in a recent rapid review of opioid use in Black communities [19]. The authors posit that identifying social determinants of health and considering the role of culture in treatment are important steps for increasing treatment initiation and retention for this population.…”

Racial Disparities in Opioid Overdose Deaths in Massachusetts

“…Since 2013, opioid-related overdose deaths have risen disproportionately among US non-Hispanic Black and Hispanic people. 1 , 2 , 3 Timely detection and policy response to these disparities require monitoring systems to signal emerging changes in overdose trends. 4 To this end, the US Centers for Disease Control and Prevention reports provisional data on drug overdose deaths 5 that can be disaggregated by state and substance, facilitating the identification of emerging trends in substance involvement.…”