Equity-oriented frameworks to inform responses to opioid overdoses: a scoping review

Abstract

Objective: The purpose of this scoping review was to systematically identify and describe literature that uses a health equity–oriented approach for preventing and reducing the harms of stigma or overdose for people who use illicit drugs or misuse prescription opioids. Inclusion criteria: To be included, papers had to both: i) use a health equity–oriented approach, defined as a response that addresses health inequities and aims to reduce drug-related harms of stigma or overdose; and ii) include at least one of the following concepts: cultural safety, trauma- and violence-informed care, or harm reduction. We also looked for papers that included an Indigenous-informed perspective in addition to any of the three concepts. Methods: An a priori protocol was published and the JBI methodology for conducting scoping reviews was employed. Published and unpublished literature from January 1, 2000, to July 31, 2019, was included. The databases searched included CINAHL (EBSCOhost), MEDLINE (Ovid), Academic Search Premier (EBSCOhost), PsycINFO (EBSCOhost), Sociological Abstracts and Social Services Abstracts (ProQuest), JBI Database of Systematic Reviews and Implementation Reports, Cochrane Database of Systematic Reviews, PROSPERO, Aboriginal Health Abstract Database, First Nations Periodical Index, and the National Indigenous Studies Portal. The search for unpublished studies included ProQuest Dissertations and Theses, Google Scholar, and targeted web searches. Screening and data extraction were performed by two reviewers using templates developed by the authors. Data extraction included specific details about the population, concepts, context, and key findings or recommendations relevant to the review objectives. Results: A total of a total of 1065 articles were identified and screened, with a total of 148 articles included. The majority were published in the previous five years (73%) and were from North America (78%). Most articles only focused on one of the three health equity–oriented approaches, most often harm reduction (n = 79), with only 16 articles including all three. There were 14 articles identified that also included an Indigenous-informed perspective. Almost one-half of the papers were qualitative (n = 65; 44%) and 26 papers included a framework. Of these, seven papers described a framework that included all three approaches, but none included an Indigenous-informed perspective. Recommendations for health equity–oriented approaches are: i) inclusion of people with lived and living experience; ii) multifaceted approaches to reduce stigma and discrimination; iii) recognize and address inequities; iv) drug policy reform and decriminalization; v) ensure harm-reduction principles are applied within comprehensive responses; and vi) proportionate universalism. Gaps in knowledge and areas for future research are discussed. Conclusions: We have identified few conceptual frameworks that are both health equity–oriented and incorporate multiple concepts that could enrich responses to the opioid poisoning emergency. More research is required to evaluate the impact of these integrated frameworks for action.

A distributed model to expand the reach of drug checking

“…Based on all of the technologies that have been evaluated over the past decade, it appears that the ideal instrument for drug checking has yet to be determined, and this is in part because of the compromise between cost, ease of use, sensitivity and utility of the results. In the near future, community drug checking will likely continue to engage multiple instruments when seeking to report on the synthetic opioids often associated with overdose and the frequent combinations of active ingredients such as "so-called benzo-dope" (Wallace et al, 2021a(Wallace et al, , 2021b(Wallace et al, , 2021c. j DRUGS, HABITS AND SOCIAL POLICY j Overall, there is a need to address the implementation barriers that are hindering its scale and reach (Wallace et al, 2021a).…”

Ethical by Design: Engaging the Community to Co-design a Digital Health Ecosystem to Improve Overdose Prevention Efforts Among Highly Vulnerable People Who Use Drugs

“…Overdoses involving opioids and other substances were declared a public health emergency in the United States in 2017 and have reached historically devastating numbers during 2021 ( 1 ). Recent data from the CDC ( 2 ) indicated that over 108,000 Americans died as a result of drug overdose during 2021, an increase of over 30% from previous years ( 3 ).…”

“…Existing overdose estimates rely almost exclusively on data from emergency management systems (EMS), emergency departments (ED), and death records, reflecting only PWUDs who interact with the healthcare system following overdose ( 4 ). Current overdose data collection methods are fragmented, insufficient, and act to marginalize people who use drugs (PWUD) in analyses ( 1 , 5 ).…”

“…The community through CBPR becomes a part of the research team ( 8 ). Central to health equity-oriented approaches is the inclusion of PWUD throughout planning, development, and implementation ( 1 ). Community involvement increases trust and efficacy of the resulting product within vulnerable populations ( 7 ).…”

“…Texans Connecting Overdose Prevention Efforts (TxCOPE) is a digital health ecosystem developed through employment of CBPR, a community engaged research approach. Similar to other states in the United States, Texas currently does not have a unified, comprehensive digital system in place for fatal and non-fatal overdose reporting and tracking, contributing to the gap in comprehensive, real-time collection, dissemination, and analysis of overdose data ( 1 ). TxCOPE will have four interconnected platforms with each tailored to fit the needs of harm reduction organizations, the general community, first responders, and healthcare providers.…”