Evaluating equity in community-based naloxone access among racial/ethnic groups in Massachusetts. (1st December 2022)

• Record Type: Journal Article
• Authors: Nolen, Shayla; Zang, Xiao; Chatterjee, Avik; Behrends, Czarina N.; Green, Traci C.; Linas, Benjamin P.; Morgan, Jake R.; Murphy, Sean M.; Walley, Alexander Y.; Schackman, Bruce R.; Marshall, Brandon D.L.
• Is Part Of: Drug and alcohol dependence. Volume 241(2022)
• Publication Date: 2022-12-01
• Subjects: Naloxone distribution -- Racial inequity -- OEND -- Opioids -- Overdose; Drug abuse -- Periodicals; Alcoholism -- Periodicals; 616.86
• DOI: 10.1016/j.drugalcdep.2022.109668
• Languages: English
• ISSNs: 0376-8716

Abstract

Abstract: Background: Racial/ethnic minorities have experienced disproportionate opioid-related overdose death rates in recent years. In this context, we examined inequities in community-based naloxone access across racial/ethnic groups in Massachusetts. Methods: We used data from: the Massachusetts Department of Public Health on community-based overdose education and naloxone distribution (OEND) programs; the Massachusetts Office of the Chief Medical Examiner on opioid-related overdose deaths, and; the United States Census American Community Survey for regional demographic/socioeconomic details to estimate community populations by race/ethnicity and racial segregation between African American/Black and white residents. Race/ethnicity groups included in the analysis were African American/Black (non-Hispanic), Hispanic, white (non-Hispanic), and "other" (non-Hispanic). We evaluated racial/ethnic differences in naloxone distribution across regions in Massachusetts and neighborhoods in Boston descriptively and spatially, plotting the race/ethnicity-specific number of kits per opioid-related overdose death per jurisdiction. Lastly, we constructed generalized estimating equations models with a negative binomial distribution to compare the race/ethnicity-specific naloxone distribution rate by OEND programs. Results: From 2016–2019, the median annual rate of naloxone kits received from OEND programs in Massachusetts per racial/ethnicity group ranged between 160 and 447 per 100, 000. In a multivariable analysis, we found that the naloxone distribution rates for racial/ethnic minorities were lower than the rate for white residents. We also found naloxone was more likely to be distributed in racially segregated communities than non-segregated communities. Conclusion: We identified racial/ethnic inequities in naloxone receipt by individuals in Massachusetts. Additional resources focused on designing and implementing OEND programs for racial/ethnic minorities are warranted to ensure equitable access to naloxone. Highlights: Evaluated racial/ethnic differences in naloxone distribution in Massachusetts. 2016–2019, racial/ethnic minorities received less community-based OEND naloxone. Regions with high overdose rates received more naloxone. Despite segregated regions receiving more naloxone, minority residents received less.