The Current Community Context of Overdose Deaths: Relations among Drug Types, Drug Markets, and Socioeconomic Neighborhood Characteristics¹

Abstract

Increases in opioid overdose deaths have been pronounced throughout the nation. The current narrative about them stresses their reach into middle-class America while theories that link substance use etiology and drug markets, such as availability-proneness theory, suggest that lower-income communities should be most impacted. The latter might be especially true due to the increased involvement of cheap and highly potent fentanyl. This study uses group-based multi-trajectory models and path analysis to assess relations among neighborhood opioid-overdose death trends, drug type compositions, and socioeconomic neighborhood characteristics across Delaware from 2013 to 2017. We find support for availability-proneness theory, insofar as drug availability and substance use are associated with neighborhoods in the trajectory groups with the highest overdose death rates. Moreover, we find that neighborhood disadvantage is associated with increased drug availability as well as substance use. Our results also suggest that open-air drug market access might be associated with an increased risk of fentanyl and heroin exposure which, in turn, can lead to spikes in overdoses net of other risk factors. Overall, our findings reveal the social character of the opioid epidemic and inform the literature on social inequality and drug use. We highlight the need for community reinvestment and harm reduction strategies to alleviate the drug problems in the most disadvantaged communities.

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

“…Conversely, among White decedents, hotspots shifted from areas characterized by a higher proportion of White residents and more socioeconomic opportunity to those high-deprivation, Black neighborhoods north of Delmar. This spatial pattern echoes previous research demonstrating fentanyl involved OOD are concentrated in resource-deprived neighborhoods [14][15]29 and supports the hypothesis that in urban areas, fentanyl distribution may be targeted to more neighborhoods with more deprivation.…”

“…Relatedly, there is some evidence to support the premise that fentanyl exposure-particularly in combination with other drugs such as heroin-is increased in open-air drug markets, which are more common in resource-deprived neighborhoods 29 and may draw White customers from surrounding areas. 30 Although Black and White OOD are increasingly occurring in the same geographic clusters, we found them associated with different characteristics, particularly during the third wave.…”

Opioid Misuse: A Review of the Main Issues, Challenges, and Strategies

“…Regarding the numerous strategies recommended to deal with the phenomenon, among the most cited, it emerges the clear urge to enhance training and information for both healthcare providers and patients [ 5 , 12 , 14 , 31 , 41 , 45 , 49 , 52 , 53 , 54 , 57 ]. This is essentially related to the recommendation to prevent rather than implement subsequent containment and corrective action [ 12 , 31 , 36 , 40 , 42 , 46 , 54 , 58 ].…”

“…Other strategies suggested by multiple contributions are to implement programs to treat opioid addiction [ 4 , 5 , 34 , 40 , 46 ] and increase research, grants, and funding in the sector [ 36 , 46 , 48 , 50 , 56 ]. In addition, many contributions support the need to implement medical care [ 31 , 36 , 42 , 43 , 46 ] and increase the prescription and use of naloxone [ 12 , 31 , 33 , 42 , 43 ]. Cordes [ 12 ] reports the results of his study as follows:…”

Drug Normalization and Conventional Social Institutions: The Unusual Case of Prescription Drug Misuse

“…The normalization of particular drugs is a key cultural process that shapes population patterns of drug use and the experiences of people who use drugs. As drug trends wax and wane (Golub and Johnson 1999), the role of normalization is uneven (MacDonald and Marsh 2002); some substances not only become increasingly common, but their use seems more ordinary among certain segments of the population, while other substances remain stigmatized and unconventional despite increases in their use (Wagner et al 2021). Often, normalization is driven from the ground up with networks of individuals who use a substance altering the landscape of how the substance in question is perceived more broadly (Measham and Shiner 2009).…”