“We know the streets:” race, place, and the politics of harm reduction

Owczarzak, Jill; Weicker, Noelle P.; Urquhart, Glenna J.; Morris, Miles; Park, Ju Nyeong; Sherman, Susan G.

doi:10.1016/j.healthplace.2020.102376

Cited by 21 publications

(15 citation statements)

References 47 publications

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“…33 Partnering with the affected communities to develop community-driven, multilevel interventions and use harm reduction approaches are possible ways to begin to combat the systemic barriers that disproportionately affect these communities. 34,35 Consistent with previous studies, our study found that among men and women with an expressed need for SUD treatment, the most common barriers to care were attitudinal (ie, having a negative opinion about treatment). 29 Furthermore, women were more likely than men to report concern about the effect of treatment on their reputation or job.…”

Section: Discussionsupporting

confidence: 90%

Need for and Receipt of Substance Use Disorder Treatment Among Adults, by Gender, in the United States

et al. 2021

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Objectives Disparities in substance use disorder (SUD) treatment use persist across groups, including gender. Using a gender-informed approach to expand treatment capacity and reduce barriers to treatment engagement is vital. We examined SUD treatment need and receipt among people with SUD in the United States, by gender, and assessed gender-specific sociodemographic factors associated with unmet need for SUD treatment and reported treatment barriers. Methods We conducted an analysis of data among adults aged ≥18 with a past-year SUD from the National Survey on Drug Use and Health (2015-2018). We computed population-adjusted frequencies and proportions for SUD treatment need and receipt and assessed gender differences. Multivariate logistic regression assessed gender-specific sociodemographic variables associated with SUD treatment receipt. Results Among adults with a past-year SUD, 63.4% were men and 36.6% were women ( P < .001), only 10.6% received SUD treatment, and a greater percentage of women than men needed treatment for opioid use disorder (11.9% vs 9.9%; P = .002). Receipt of SUD treatment was lowest among women with alcohol use disorder followed by men with alcohol use disorder (7.5% vs 8.9%; P = .052). Non-Latinx Black men had fewer than half the adjusted odds of receiving SUD treatment than non-Latinx White men (adjusted odds ratio [aOR] = 0.44; 95% CI, 0.27-0.71). Latinx women (aOR = 0.37; 95% CI, 0.18-0.73) and non-Latinx Black women (aOR = 0.51; 95% CI, 0.27-0.94) had significantly lower odds of receiving SUD treatment than non-Latinx White women. Conclusions As public health efforts target expanding SUD treatment capacity and addressing disparities in use of SUD treatment, interventions informed by gender and culture should be prioritized.

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Section: Discussionsupporting

confidence: 90%

Need for and Receipt of Substance Use Disorder Treatment Among Adults, by Gender, in the United States

et al. 2021

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“…Patients who need a higher level of care are provided a warm handoff to a community-based program. This approach aligns with previous studies that have shown improvement in OUD outcomes with harm reduction programs [ 61 , 62 ]. Second, the SUD treatment clinic has on-site addiction medicine providers from multiple specialties including psychiatry, internal medicine, family medicine, obstetrics and gynecology, and emergency medicine who are waivered to prescribe buprenorphine.…”

Section: Discussionsupporting

confidence: 84%

Treatment Outcomes Among Black Adults Receiving Medication for Opioid Use Disorder

Parlier-Ahmad

Pugh

Martin

2021

J. Racial and Ethnic Health Disparities

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Largely due to structural racism, Black people with substance use disorder have worse outcomes than their White counterparts. The opioid epidemic has amplified these racial disparities. Little is known about strengths that buffer against the systemic issues that disproportionately impact Black adults with opioid use disorder (OUD), particularly those receiving buprenorphine for OUD. The objectives of this study are to (1) assess psychosocial and clinical predictors of OUD outcomes and (2) explore differences in OUD outcomes by gender among a sample of Black adults receiving buprenorphine. This is a secondary data analysis of a cross-sectional survey and medical record review with a convenience sample recruited from an addiction medicine clinic. Analyses included Black participants who provided at least one urine drug test during the study period (n = 98). Prospective 6-month OUD outcomes (treatment retention, substance use recurrence, and buprenorphine continuation) were abstracted from the medical record. Univariate analyses explored differences by gender. Multivariate regressions assessed predictors of OUD outcomes. Participants were 53% women and middle-aged (47 ± 12 years). The majority (59%) had been in treatment for at least 1 year at study enrollment. Substance use recurrence was common, but many individuals remained in treatment. OUD outcomes did not differ by gender. Older age and absence of injection opioid use history were significant predictors of treatment retention and buprenorphine continuation. When provided access to high-quality treatment, Black adults with OUD demonstrate positive outcomes. Addressing structural racism and developing culturally informed treatment interventions are necessary to improve access to high-quality care for this community.Keywords Black adults . Opioid use disorder (OUD) . Medication for opioid use disorder (MOUD) . Buprenorphine . Social determinants of health

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“…Our nding that Black participants were considerably less likely to have protected use events may re ect an ongoing broader lack of access to the medication and understandable hesitancy to engage harm reduction resources more generally in some communities due to legacies of harm done onto communities of people of color by medical institutions [45,46]. This points to the need for tailored harm reduction developed by and for communities of people of color, in addition to outreach to underserved communities guided by community members.…”

Section: Discussionmentioning

confidence: 99%

Naloxone Protection, Social Support, Network Characteristics, and Overdose Experiences Among a Cohort of People Who Use Illicit Opioids in New York City

Bennett

Scheidell

Bowles³

et al. 2021

Preprint

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Background Despite increased availability of take-home naloxone, many people who use opioids do so in unprotected contexts, with no other person who might administer naloxone present, increasing the likelihood that an overdose will result in death. Thus, there is a social nature to being “protected” from overdose mortality, which highlights the importance of identifying background factors that promote access to protective social networks among people who use opioids. Methods We used respondent-driven sampling to recruit adults residing in New York City who reported recent (past 3-day) nonmedical opioid use (n=575). Participants completed a baseline assessment that included past 30-day measures of substance use, overdose experiences, and number of “protected” opioid use events, defined as involving naloxone and the presence of another person who could administer it, as well as measures of network characteristics and social support. We used modified Poisson regression with robust variance to estimate unadjusted and adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs). Results 66% of participants had ever been trained to administer naloxone, 18% had used it in the past three months, and 32% had experienced a recent overdose (past 30 days). During recent opioid use events, 64% reported never having naloxone and a person to administer present. This was more common among those: aged ≥50 years (PR: 1.18 (CI: 1.03, 1.34); who identified as non-Hispanic Black (PR: 1.27 (CI: 1.05, 1.53); experienced higher levels of stigma consciousness (PR: 1.13 (CI: 1.00, 1.28); and with small social networks (<5 persons) (APR: 1.14 (CI: 0.98, 1.31). Having a recent overdose experience was associated with severe opioid use disorder (PR: 2.45 (CI: 1.49, 4.04), suicidality (PR: 1.72 (CI: 1.19, 2.49), depression (PR: 1.54 (CI: 1.20, 1.98) and positive urinalysis result for benzodiazepines (PR: 1.56 (CI: 1.23, 1.96), but not with network size. Conclusions Results show considerable gaps in naloxone protection among people who use opioids, with more vulnerable and historically disadvantaged subpopulations less likely to be protected. Larger social networks of people who use opioids may be an important resource to curtail overdose mortality, but more effort is needed to harness the protective aspects of social networks.

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“We know the streets:” race, place, and the politics of harm reduction

Cited by 21 publications

References 47 publications

Need for and Receipt of Substance Use Disorder Treatment Among Adults, by Gender, in the United States

Need for and Receipt of Substance Use Disorder Treatment Among Adults, by Gender, in the United States

Treatment Outcomes Among Black Adults Receiving Medication for Opioid Use Disorder

Naloxone Protection, Social Support, Network Characteristics, and Overdose Experiences Among a Cohort of People Who Use Illicit Opioids in New York City

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