Opioid‐related overdose deaths among African Americans: Implications for research, practice and policy

Stevens‐Watkins, Danelle

doi:10.1111/dar.13058

Cited by 19 publications

(26 citation statements)

References 63 publications

(81 reference statements)

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“…Conversely, African Americans and Hispanics both had statistically significant increases in OOD during that same period [3]. Multiple factors have been posited to explain this disparate increase, including concomitant illicit drug use among African Americans, increased probability that illicit drugs purchased and used by African Americans are adulterated with fentanyl and lower perception of risk among African Americans [4].…”

Section: Introductionmentioning

confidence: 99%

African Americans now outpace whites in opioid‐involved overdose deaths: a comparison of temporal trends from 1999 to 2018

et al. 2020

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Aims To estimate racial differences in rates of opioid‐involved overdose deaths (OOD) between whites and African Americans in the United States from 1999 to 2018 to (1) identify racial variation in the temporal trends of OOD during the 20‐year period and (2) compare trends in OOD rates between whites and African Americans using the Centers for Disease Control and Prevention's (CDC) three defined OOD epidemic periods. Methods Data were obtained from the CDC wide‐ranging on‐line data for epidemiological research, which combines OOD data from the National Vital Statistics System, and population data from the US Census Bureau. Joinpoint regression models were used to estimate age‐adjusted annual percentage change (APC) in OOD by race from 1999 to 2018. Results The temporal trends of OOD varied by race. African Americans had a persistently low rate of OOD and statistically non‐significant rate of change in OOD from 1999 to 2012 (APC = 0.47; P > 0.05), with a statistically significant and rapid acceleration in OOD rates in 2012 that persisted to 2018 (APC = 26.16; P < 0.01). Whites had three statistically significant periods of acceleration in OOD rate from 1999 to 2006 (APC = 12.43; P < 0.01), 2006 to 2013 (APC = 4.34, P < 0.01) and the greatest increase from 2013 to 2016 (APC = 18.96; P < 0.01). Whites had a statistically non‐significant decrease in OOD from 2016 to 2018 (P = 0.16). The trend for whites more closely aligned with the CDC‐defined epidemic periods than for African Americans. During wave 1 (1999–2010), the average annual percentage change (AAPC) for African Americans was significantly lower than for whites (0.47 versus 9.42, P < 0.01); however, by wave 3 (2013–current; defined by the introduction of illicitly manufactured fentanyl), the AAPC was significantly higher in African Americans (26.16 versus 13.19, P < 0.01). Conclusions Despite historically lower rates of opioid misuse and opioid‐involved overdose deaths among African Americans compared with whites, the growth in opioid‐involved overdose deaths among African Americans now outpaces that of whites in the United States.

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Section: Introductionmentioning

confidence: 99%

African Americans now outpace whites in opioid‐involved overdose deaths: a comparison of temporal trends from 1999 to 2018

et al. 2020

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“…From a research standpoint, it is imperative to continue examining the confounding influence of the COVID-19 pandemic on individuals who are at risks resulting from NPF as the combined crisis could lead to increased health disparities over time [ 46 ] especially for ethnic minority populations [ 47 ] and those experiencing homelessness [ 48 ]. Lastly, research efforts that seek to develop and test new means of community-wide surveillance will become critical [ 49 ] for the development of a more timely and geographically targeted delivery of harm reduction services and interventions.…”

Section: Discussionmentioning

confidence: 99%

“They say it’s fentanyl, but they honestly look like Perc 30s”: Initiation and use of counterfeit fentanyl pills

Daniulaityte

Sweeney

et al. 2022

Harm Reduct J

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Background Worsening of the overdose crisis in the USA has been linked to the continuing proliferation of non-pharmaceutical fentanyl (NPF). The recent wave of NPF spread in the USA has been fueled by an increased presence of counterfeit pills that contain NPF. This qualitative study aims to characterize the motivation and practices of counterfeit NPF pill initiation and use among individuals using illicit opioids in Arizona. Methods Between October 2020 and May 2021, semi-structured interviews were conducted with 22 individuals meeting the following eligibility criteria: (1) 18 years or older; (2) residence in Arizona; and (3) use of illicit opioids in the past 30 days and/or opioid use disorder treatment in the past 12 months. Participants were recruited through referrals by a harm reduction organization, craigslist ads, and referrals by other participants. Interviews were conducted virtually via Zoom. Qualitative interviews were transcribed and analyzed thematically using NVivo. Results Out of 22 participants, 64% were male, and 45% were ethnic minorities. Age ranged between 25 and 51 years old. Participants noted significant recent increases in the availability of counterfeit NPF pills (“blues,” “dirty oxys”) that were most commonly used by smoking. The majority indicated first trying NPF pills in the past year, and the first use often occurred in situations of reduced access to heroin or pharmaceutical opioids. Participant decisions to switch over to more frequent NPF pill use or to maintain some levels of heroin use were shaped by local drug availability trends and personal experiences with NPF effects. They were also influenced by conflicting views of social acceptability of pharmaceutical-like drugs, perceived harms of NPF in terms of overdose risks and increased difficulty of quitting, and perceived benefits of switching to the non-injection route of opioid administration (e.g., from injecting heroin to smoking NPF pills). Conclusion Our findings highlight the need for the implementation of novel policy, treatment, and harm reduction approaches to address the growing unpredictability of drug supply and NPF pill-specific risks, attitudes, and behaviors.

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“…Furthermore, when Black and Latinx individuals have sought services related to opioid misuse, they have been less likely to receive high quality treatment due to a range of structural barriers including lack of insurance, lack of community services, provider mistrust and bias, and stigma [ 44 – 47 ]. The third wave of the epidemic hit these communities harder than previous waves: Black and Latinx communities have seen a sharp rise in opioid-related fatal and non-fatal overdoses since 2016, with increases in deaths now outpacing Whites [ 9 , 48 ]. This history of racism is essential context for understanding Southern HSO implementation of HR, since the HIV epidemic in the South has disproportionately impacted Black and Latinx communities and it is therefore Black and Latinx individuals who are primarily served by these organizations.…”

Section: Study Aim One Findings: the Political And Social Context Of ...mentioning

confidence: 99%

Harm reduction implementation among HIV service organizations (HSOs) in the U.S. south: a policy context analysis and results from a survey of HSOs

Stanton

Ali

McCormick

2022

BMC Health Serv Res

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Background HIV service organizations are integral to serving communities disproportionately impacted by the HIV and opioid epidemics in the U.S. South. Addressing these intersecting epidemics requires implementation of evidence-based approaches, such as harm reduction. However, little is known about the extent to which Southern HIV service organizations implement harm reduction. This manuscript examines: 1) the implementation context of harm reduction in the South, 2) Southern HIV service organization implementation of harm reduction, and 3) the impact of different contexts within the South on HIV service organization implementation of harm reduction. Methods To examine implementation context, authors analyzed nation-wide harm reduction policy and drug-related mortality data. To examine HIV service organization implementation of harm reduction, authors performed frequency distributions on survey data (n = 207 organizations). Authors then constructed logistic regressions, using state mortality data and policy context as predictors, to determine what contextual factors predicted HIV service organization implementation of harm reduction. Results Drug-related mortality data revealed an increased need for harm reduction, and harm reduction policy data revealed an increased political openness to harm reduction. Frequency distributions revealed that approximately half of the HIV service organizations surveyed reported that their organizations reflect a harm reduction orientation, and only 26% reported providing harm reduction services. Despite low utilization rates, HIV service organizations indicated a strong interest in harm reduction. Logistic regressions revealed that while increased mortality rates do not predict HIV service organization implementation of harm reduction, a harm reduction-friendly policy context does. Discussion This study highlights how regions within a high-income country can face unique barriers to healthcare and therefore require a unique understanding of implementation context. Study findings indicate a rapidly changing implementation context where increased need meets increased political opportunity to implement harm reduction, however there is a lag in HIV service organization adoption of harm reduction. Financial resources, capacity building, and continued policy advocacy are required for increased HIV service organization adoption of harm reduction.

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Opioid‐related overdose deaths among African Americans: Implications for research, practice and policy

Cited by 19 publications

References 63 publications

African Americans now outpace whites in opioid‐involved overdose deaths: a comparison of temporal trends from 1999 to 2018

African Americans now outpace whites in opioid‐involved overdose deaths: a comparison of temporal trends from 1999 to 2018

“They say it’s fentanyl, but they honestly look like Perc 30s”: Initiation and use of counterfeit fentanyl pills

Harm reduction implementation among HIV service organizations (HSOs) in the U.S. south: a policy context analysis and results from a survey of HSOs

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