An Evaluation of Opioid Use in Black Communities: A Rapid Review of the Literature.

BACKGROUND: There are multiple aspects of the opioid crisis among Black people, who have been left out of the broader conversation. Despite evidence of increased opioid overdose deaths, less is known about opioid use among Black people. This review synthesizes research on Black people who use opioids; the goals are to advance knowledge, highlight research gaps, and inform clinical practice. METHODS: This rapid review investigating opioid use among Black people utilized systematic review methods and was conducted according to a predefined protocol with clear inclusion criteria (PROSPERO ID: 177071). A comprehensive search strategy was used, including published and gray-literature sources (i.e., literature that has not been formally published). A narrative summary of the results is presented. RESULTS: A total of 76 works were selected for inclusion and full text review. Sex, age, geographic location, and involvement in the carceral system were associated with the use of opioids among Black individuals. Non-epidemiologic factors included treatment-seeking patterns, disparate clinician prescribing, and social determinants. CONCLUSIONS: Through this rapid review we suggest three main areas of focus: (1) including culturally informed collection methods in epidemiologic surveys to accurately reflect prevalences, (2) funding research that specifically addresses the importance of culture in accessing treatment, and (3) directly studying how social determinants can improve or exacerbate health outcomes. Focusing on the unique needs of Black people who use opioids is warranted to increase treatment initiation and adherence among a population less likely to engage with the traditional health care system.

Achieving Mental Health Equity: Addictions.

Despite available treatment options for addiction, there remains an abysmal uptake of treatment initiation and engagement among varying communities. The existing treatment gap is based on historical occurrences, including discriminatory drug policies that have targeted communities of color with addiction. The current opioid epidemic and differential treatment therein exemplifies the severity of the existing disparity in addiction treatment, highlighting barriers such as institutionalized racism and vulnerabilities in the social determinants of health. To mitigate the disparity, an array of solutions to address these inequities are discussed, thereby providing a pathway forward to eliminating this treatment gap.

Colorblind Algorithms: Racism in the Era of COVID-19.

This commentary offers a critique of the recent policy document issued by White et al. (2020) to guide critical care resource (e.g. ventilators) allocation during public health emergencies such as COVID-19. We argue that, if disseminated widely, this criteria would result in a racially inequitable resource distribution in the current COVID-19 crisis. We link the White et al. (2020) resource distribution protocol to other "colorblind" healthcare algorithms that have relied on seemingly objective but fundamentally biased data, thereby reinforcing and exacerbating pre-existing racial health disparities. We suggest a health equity framework to ensure unbiased distribution of critical care resources during COVID-19 and in general practice.