Lessons for the Opioid Crisis-Integrating Social Determinants of Health Into Clinical Care
American Journal of Public Health
; 112:S109-S111, 2022.
Article
in English
| ProQuest Central | ID: covidwho-1777043
ABSTRACT
Overdose deaths accelerated with the emergence of COVID-19, and this acceleration was fastest among Black, Latinx, and Native Americans, whose overdose rates had already increased before COVID-19.1,2 COVID-19 led to limits on access to medications for opioid use disorder and harm-reduction services, exacerbating low treatment and retention rates,3-5 in the face of toxic drug supplies laced with high-potency synthetic opioids.6 Disproportionate deaths from substance use disorders (SUDs) and from COVID-19 among low-income people marginalized by race, ethnicity, and migrant status have similar upstream causes of exposure, including unstable and crowded housing, high-risk employment or unemployment, and high levels of policing and incarceration, combined with low levels of access to health care and preventive measures. Punitive drug law enforcement discourages help seeking and treatment and leads to unstable drug supplies that are contaminated with fentanyl and other high-potency synthetic opioids that heighten overdose risk.10 Incarcerated people are at an elevated risk of drug overdose in the weeks following release,11 and communities with high incarceration rates have higher mortality.12 Drug courts disproportionately cite low-income people of color for infractions, leading to imprisonment rather than treatment.13 Economic precarity and unstable housing disrupt the social networks that sustain health and prevent overdose.14 Urban planners often displace residents of Black and Latinx neighborhoods, leaving them exposed to narcotic trade and HIV.15 The child welfare system disproportionately removes low-income Black, Latinx, and Indigenous children from families affected by SUDs, and children raised in foster care are at high risk for SUDs.16,17 Therefore, reducing SUD-related deaths and disability requires the redress of discriminatory public policies. Studies of integration of buprenorphine maintenance with organized healing sessions, fishing, hunting, and community gardening in Canadian First Nations communities have shown high rates oftreatment retention (74%) at 18 months,22 and healing sessions combined with buprenorphine have had high levels oftreatment participation, community-level reductions in criminal charges and child protection measures, increased school attendance, and increased flu vaccination.23 Faith-Based Organizations as Partners Imani Breakthrough is a culturally informed approach based on a partnership of Yale University Department of Psychiatry clinicians with Black and Latinx churches. CONCLUSIONS Clinicians can use their symbolic capital to advocate policies that address SDOH and collaborate with community organizations and nonhealth sectors to identify and act on institutional barriers to their patients' health, such as through a structural competency approach.25 Health systems must engage communities, destigmatize SUD, and link to social services with locally controlled, adaptable funds akin to the Ryan White CARE Act to build community-based infrastructure accessible, trusted services including in cultural, faith-based, and harm-reduction organizations as well as local businesses such as pharmacies.
Medical Sciences; Neighborhoods; Community organizations; Unemployment; Drug abuse; Social services; Narcotics; Community involvement; Low income groups; Native North Americans; Gardening; Drug use; Income; Foster care; Children & youth; Race; Psychiatry; Law enforcement; Imprisonment; Disease transmission; Reduction; Social networks; Trends; Employment; Opioids; Public policy; Mental health services; Community structure; Housing; Community; Health services; Ethnicity; Health care industry; Policies; Overdose; Human immunodeficiency virus--HIV; Social organization; Substance use; Healing; Addictions; Residents; Buprenorphine; American Indians; Minority & ethnic groups; Collaboration; Immunization; Influenza; COVID-19; Risk; Health care; Crime; Retention; Mental health; Acquired immune deficiency syndrome--AIDS; Public health; Vaccination; Churches; Fatalities; Hunting; Urban planning; Repair and maintenance; Organizations; Fishing; Foster children; Fentanyl; Drug overdose; Children; Prevention; Fishing communities; School attendance; Community participation; Los Angeles California; United States--US; 92115:American Indian and Alaska Native Tribal Governments
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Collection:
Databases of international organizations
Database:
ProQuest Central
Type of study:
Prognostic study
Language:
English
Journal:
American Journal of Public Health
Year:
2022
Document Type:
Article
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