Campbell Kaytryn D, Winograd Rachel P, Paschke Maria E, Duello Alex, Banks Devin E
Department of Psychological Sciences, University of Missouri- St. Louis, One University Dr, 325 Stadler Hall, St. Louis, MO, 63121, USA.
Missouri Institute of Mental Health, University of Missouri-St. Louis, One University Dr., B2017, St. Louis, MO, 63121, USA.
Harm Reduct J. 2025 Apr 28;22(1):67. doi: 10.1186/s12954-025-01224-w.
Despite significant efforts to address the opioid overdose crisis, Black people who use drugs (PWUD) face unabating, disproportionate increases in opioid overdose death (OOD) rates. These inequities persist in treatment admissions, utilization of medication for opioid use disorder, and treatment retention. Research has linked neighborhood disinvestment - a process of urban decline driven by policy-related changes in neighborhood demand and desirability leading to decreased population, physical and economic erosion, and poorer quality of life for residents - to increased rates of OOD. However, given recent increases in OOD inequities, more research is needed to determine the specific aspects of neighborhood disinvestment that drive OOD risk among Black PWUD.
The current qualitative study utilized a community-engaged research approach to conduct focus groups with stakeholders providing support to PWUD in Black neighborhoods in order to identify the facets of neighborhood disinvestment that contribute and mitigate increases of OOD among Black PWUD in St. Louis, Missouri.
The resulting thematic analysis identified four themes linking neighborhood disinvestment to increased rates of OOD among Black PWUD: (1) a lack of access to congruent treatment and services, (2) intergenerational and socioemotional lack of mobility, (3) lack of financial accountability and investment from local leadership and government, and (4) the loss of collective community responsibility and engagement. A fifth theme brought attention to a culturally-grounded strategy being used to reduce these rates: (5) building engagement and community cohesion through grassroots efforts and street outreach.
Findings provide key implications for policy and practice, including the importance of adopting a community-based research framework, offering financial management training for Black-led organizations, and harnessing community champions to implement culturally-tailored interventions aimed at reducing stigma and raising critical consciousness. Future work should aim to identify more effective community-driven solutions to address OOD in Black neighborhoods.
尽管为应对阿片类药物过量危机付出了巨大努力，但吸毒的黑人面临着阿片类药物过量死亡率持续且不成比例的上升。这些不平等现象在治疗入院、阿片类药物使用障碍药物的使用以及治疗保留方面依然存在。研究将社区投资减少——这是一种由社区需求和吸引力方面与政策相关的变化驱动的城市衰退过程，导致人口减少、物质和经济衰退以及居民生活质量下降——与阿片类药物过量死亡率上升联系起来。然而，鉴于近期阿片类药物过量不平等现象的增加，需要更多研究来确定社区投资减少中导致黑人吸毒者阿片类药物过量风险的具体方面。
当前的定性研究采用社区参与式研究方法，与在密苏里州圣路易斯市黑人社区为吸毒者提供支持的利益相关者进行焦点小组讨论，以确定社区投资减少中导致和减轻黑人吸毒者阿片类药物过量增加的方面。
由此产生的主题分析确定了将社区投资减少与黑人吸毒者阿片类药物过量率增加联系起来的四个主题：（1）难以获得合适的治疗和服务，（2）代际间和社会情感方面缺乏流动性，（3）地方领导人和政府缺乏财政问责制和投资，（4）集体社区责任和参与的丧失。第五个主题提请注意一种用于降低这些比率的基于文化的策略：（5）通过基层努力和街头外展建立参与和社区凝聚力。
研究结果为政策和实践提供了关键启示，包括采用基于社区的研究框架的重要性、为黑人领导的组织提供财务管理培训，以及利用社区倡导者实施旨在减少耻辱感和提高批判意识的文化定制干预措施。未来的工作应旨在确定更有效的社区驱动解决方案，以解决黑人社区的阿片类药物过量问题。
