Department of Psychological Sciences, University of Missouri-St. Louis, One University Blvd., 325 Stadler Hall, St. Louis, MO, USA.
Missouri Institute of Mental Health, University of Missouri-St. Louis, One University Blvd., St. Louis, MO, USA.
Harm Reduct J. 2023 Jan 13;20(1):5. doi: 10.1186/s12954-023-00734-9.
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.
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.
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.
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.
尽管美国联邦政府努力缓解阿片类药物危机，但美国黑人的致命阿片类药物过量率仍不成比例地增加。本研究旨在根据关键利益相关者的经验，探讨导致美国黑人阿片类药物过量死亡的原因。
在密苏里州圣路易斯的黑人社区，与提供药物使用预防服务的利益相关者进行了焦点小组讨论（n=14）。一个焦点小组包括从事基于外展服务的同伴倡导者和志愿者，另一个小组包括积极的社区卫生工作者。焦点小组在参与者熟悉的社区合作伙伴组织中举行。数据收集由带有开放式提示的访谈指南协助。焦点小组进行了录音，并由专业人员进行了转录。使用扎根理论对转录本进行分析，将逐行编码抽象为更高阶的主题，并解释它们的关联。
从参与者的叙述中确定了一个核心主题，即黑人个体的阿片类药物过量死亡是由安全、保障、稳定和生存（4S）需求未得到满足驱动的。缺乏 4S 反映了结构上的投资不足以及医疗保健和社会服务障碍，这些障碍是由系统性种族主义造成的。参与者未满足的 4S 需求与健康和社会后果相关，这些后果会导致过量用药，并对康复努力产生不利影响。参与者确定了可能满足 4S 需求并减轻黑人社区中过量用药的文化和基于关系的策略。
在当地社区解决阿片类药物过量种族不平等问题的关键利益相关者强调了促进基本社会经济需求的上游干预的重要性。利用同伴服务的当地外展工作可以提供文化上一致的干预措施，并促进传统上未被美国卫生和社会系统服务的黑人社区的减少伤害。
