Stigma and drug use settings as correlates of self-reported, non-fatal overdose among people who use drugs in Baltimore, Maryland

Abstract

Background-Fatalities from opioid overdose quadrupled during the last 15 years as illicit opioid use increased. This study assesses how stigma and drug use settings are associated with non-fatal overdose to identify targets for overdose risk reduction interventions and inform overdose education and naloxone distribution programs. Methods-We surveyed 444 people who used drugs in Baltimore, Maryland, USA, from 2009-2013 as part of a randomized clinical trial of a harm reduction intervention. Participants reported demographic characteristics, drug use, overdose history, use of a local syringe services program, involvement in the local drug economy, and whether they experienced discrimination from others (i.e. enacted stigma) or stigmatized themselves (i.e., internalized stigma) related to their drug use. We used multinomial logistic regression models to identify correlates of experiencing a non-fatal overdose within the past year or >1 year ago relative to participants who never experienced an overdose. Results-Stigma was positively associated with experiencing a nonfatal overdose in the past year (adjusted Odds Ratio [aOR]: 1.7, 95% Confidence Interval [CI]: 1.1-2.7) and >1 year ago (aOR [95% CI]: 1.5 [1.1-2.0]) after adjustment for demographic and substance use characteristics. The association of stigma with overdose was stronger for enacted versus internalized stigma. The number of public settings (shooting gallery, crack house, abandoned building, public bathroom, Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Stigma as a fundamental hindrance to the United States opioid overdose crisis response

“…[ [73][74][75][76][77][78]. Enacted stigma has also been directly associated with nonfatal overdose [79]. Tertiary prevention is compromised when the stigma attached to OUDs affects access to treatment and harm reduction services.…”

The Role of the Social Network in Fatal Opioid Overdose Prevention: The Former Opioid User’s Perspective

“…There is also limited information on the settings of opioid use and overdose of PWUO that could help identify which members of the social network may have the opportunity to administer naloxone (Bonar & Bohnert, 2016; Green et al, 2015; Richert, 2015). The available literature suggests that fatal opioid overdoses commonly occur in the user’s home (Easterling et al, 2016), abandoned buildings, public bathrooms, and outside (Latkin et al, 2019). Based on limited investigations, some researchers recommend that PWUO who engage in frequent public use are likely to witness an overdose and, thus, should be recruited for OEND programs (Latkin et al, 2018).…”

“People Don’t Just Start Shooting Heroin on Their 18th Birthday”: A Qualitative Study of Community Stakeholders’ Perspectives on Adolescent Opioid Use and Opportunities for Intervention in Baltimore, Maryland

“…In light of prior research including our own documenting that Black and Hispanic/Latino youth in some cities, including Baltimore bear some of the highest rates of opioid use nationwide (Jones et al, 2019 ), future studies should explore whether stigma interacts with race to influence service utilization as described by stakeholders interviewed in this study. Additionally, the relationships of stigma to underutilization of services and overdose risk (Latkin et al, 2019 ; Tsai et al, 2019 ) encourages deeper investigation into this relationship and its relevance to developing culturally congruent prevention, treatment and harm reduction approaches in diverse communities.…”