Identifying drivers of increasing opioid overdose deaths among black individuals: a qualitative model drawing on experience of peers and community health workers

Abstract

Background Black individuals in the USA face disproportionate increases in rates of fatal opioid overdose despite federal efforts to mitigate the opioid crisis. The aim of this study was to examine what drives increases in opioid overdose death among Black Americans based on the experience of key stakeholders. Methods Focus groups were conducted with stakeholders providing substance use prevention services in Black communities in St. Louis, MO (n = 14). One focus group included peer advocates and volunteers conducting outreach-based services and one included active community health workers. Focus groups were held at community partner organizations familiar to participants. Data collection was facilitated by an interview guide with open-ended prompts. Focus groups were audio recorded and professionally transcribed. Transcripts were analyzed using grounded theory to abstract line-by-line codes into higher order themes and interpret their associations. Results A core theme was identified from participants’ narratives suggesting that opioid overdose death among Black individuals is driven by unmet needs for safety, security, stability, and survival (The 4Ss). A lack of The 4Ss was reflective of structural disinvestment and healthcare and social service barriers perpetuated by systemic racism. Participants unmet 4S needs are associated with health and social consequences that perpetuate overdose and detrimentally impact recovery efforts. Participants identified cultural and relationship-based strategies that may address The 4Ss and mitigate overdose in Black communities. Conclusions Key stakeholders working in local communities to address racial inequities in opioid overdose highlighted the importance of upstream interventions that promote basic socioeconomic needs. Local outreach efforts utilizing peer services can provide culturally congruent interventions and promote harm reduction in Black communities traditionally underserved by US health and social systems.

Examining increasing racial inequities in opioid overdose deaths: A spatiotemporal analysis of Black and White decedents in St. Louis, Missouri, 2011-2021

“…19,31 Qualitative work has shown Black people are hesitant to call the police in response to an overdose even in the context of Good Samaritan Laws due to previous experiences with police maltreatment and a strong distrust of police. 32,33 Taken together, these results point to potential targets for local intervention among Black people who use drugs. Future research should use GIS to identity spatially varying social determinants of health specifically associated with Black OOD to identify targets for reducing racial inequities.…”

Examining the relationship between social determinants of health, measures of structural racism and county-level overdose deaths from 2017–2020

“…However, evidence also suggests that the impact of the opioid epidemic on Black Americans have been underreported, with the recent increase in overdose deaths due to heroin or fentanyl disproportionately affecting Black communities [ 36 ]. Our finding that overdose rates are significantly higher in counties with both a higher percentage of Black residents and per capita fine and forfeiture revenue suggests that structural forces, including racialized policing and enforcement of monetary sanctions, may be contributing to disparities in overdose deaths in communities with a higher percentage of Black residents, along with other factors that impact detrimental substance use outcomes in Black communities, including a lack of funding and resources for SUD treatment and other social services [ 37 ].…”

Outcomes of State Targeted/Opioid Response Grants and the Medication First Approach: Evidence of Racial Inequities in Improved Treatment Access and Retention

“…High rates of poverty, homelessness, incarceration, unemployment, over-policing, and gun violence, coupled with low funding for education and the low rates of redevelopment and repopulation persist in North St. Louis, combine to serve as powerful treatment barriers. 42…”

“…High rates of poverty, homelessness, incarceration, unemployment, overpolicing, and gun violence, coupled with low funding for education and the low rates of redevelopment and repopulation persist in North St. Louis, combine to serve as powerful treatment barriers. 42 Relatedly, traditional SUD treatment services lack intentional implementation of culturally responsive strategies that address the environmental obstacles described above and deeply resonate with Black individuals being served. 43 Specifically, approaches that include faith-based interventions, 44 matching Black clients with Black clinicians, education about adaptive relational supports in clients' own communities, recovery support services that address structural barriers 32 and provide recognition, affirmation, and mitigation of "healthy mistrust" of MOUD based on historical and current examples of mistreatment of Black clients in healthcare and substance use treatment settings 45,46 have demonstrated promise and should be expanded.…”