There has been an increase in racial and ethnic differences in access to and outcome of treatment for patients with substance use disorders (SUDs), despite strong efforts in the United States to address the epidemic of drug overdose deaths. Overdose mortality rates are rising faster than blacks, Latinos, and American Indians and white Alaska Native populations.1 Members of some of these groups also use drugs to suppress opioid use (e.g., methadone, buprenorphine, and naltrexone) at a lower rate, have poorer health outcomes in the context of LDS, and are likely to be jailed for police targets and drugs. than white owners.2 Addressing the epidemic of overdose requires the elimination of racial and ethnic disparities (along with socioeconomic, gender, and geographical inequalities) in LDC prevention and care. Prioritizing policy-based research can help advance equity in SUD-related outcomes.
Existing differences highlight areas for improvement, including the implementation of research findings. There are opportunities to improve access to evidence-based treatment in uninhabited populations. Numerous trials have documented the efficacy of drugs for opioid use disorders and other SUD interventions. But such treatments are often less available to members of historically excluded groups than to white patients. Ensuring that all people with LDS receive evidence-based treatment will require overcoming barriers to high-quality care, such as lower rates of adequate health insurance than the white populations of Blacks, Latinx, and American Indians and Alaska Natives; A shortage of community clinics that treat uninsured and underinsured people; Stigma surrounding SUDs; sub-investment by the public sector in historically marginalized communities; and limited access to digital tools in many of these communities. Possible approaches to address these needs include the development of evidence-based and culturally informed telehealth models, the establishment of mobile units to deliver drugs for opioid use disorders, support for drug supply to pharmacies, the adoption of equity-based models of collaborative support and broadening access. high-quality care through collaboration between the criminal justice system and community providers, such as outpatient treatment programs and mental health clinics.3
Another option is to address the social determinants of health. There has been limited research on how to most effectively address social determinants of health in order to improve SUD-related outcomes; approaches include focusing on underlying issues related to structural racism (e.g., inequalities in housing, food, employment, and criminal justice systems based on race and ethnicity) and helping people recovering from SUDs to become more involved in society. For example, the positive effects of equitable access to housing and employment can help to address the inappropriate behaviors associated with LDCs that perpetuate drug use.
Research examining ways in which social determinants of health affect participation in SUD treatment and SUD-related outcomes may help to reduce inequalities in these areas. Studies that focus on approaches to social determinants in clinical practice — including collaborating with community services (e.g., faith-based organizations, local businesses, and nonprofits) and participating with communities — could also help to narrow these gaps. access to care and outcomes.
Prevention is another major focus. It is important that people develop and implement interventions that reduce their chances of being abused or abused by opioids and other drugs. In addition to addressing social determinants of health, preventive interventions may prioritize populations at high risk for developing LDS, such as people prescribed opioids for pain or people with LDS or a family history of psychiatric conditions, but may not have started using the substance. For people who have started using drugs, early recognition and intervention can prevent an increase in drug use and a shift to SUD. Some such interventions have already been developed, but more research is needed to ensure that they are acceptable and effective in a variety of races and ethnicities, and to avoid increasing inequalities.4
One last option is to support data science. Advances in data collection and modeling will be needed to support end-users of data – such as formal health systems, de facto (e.g., criminal justice) and policy makers – perspectives that benefit all groups and do not perpetuate structural systems. racism. Examples of such advances include the evaluation of biased data and algorithms, the inclusion of information on substance use and social determinants of health in electronic medical records (with appropriate safeguards to protect patient confidentiality), the integration of electronic medical records and other information, and the linking of various databases. and using simulations or distributed research and data networks to assess the effects of ongoing or planned interventions on specific groups.
Several steps will be needed to ensure that research reduces inequality. The first step is to include members of the groups represented in the development of prevention interventions and treatments. The involvement of such teams can help researchers determine which research is most relevant to their communities, increase the acceptability of adaptive interventions, and use measures that are relevant to patients. People with personal experience with SUD and their families can participate in the design of the studies and throughout the study period.
The second step is to properly hire members of historically underestimated groups, including those with different levels of education, and ensure that their studies are large enough to measure racial and ethnic differences in outcomes. Systematic reviews by the U.S. Agency for Health Research and Quality and the U.S. Preventive Services Task Force often do not find sufficient data among the least likely groups to evaluate prevention and treatment approaches.5 Recruitment of significant study populations will require deliberate efforts to ensure equitable outreach and to overcome mistrust of medical research among these communities, stemming from a long history of exploitation and research practices. The use of research methods that take into account cultural differences (including data acquisition, measurement, and analytical approaches) would broaden the knowledge base.
Third, researchers can increase the likelihood of programs being accepted, effectively implemented, and maintained by establishing and engaging in equitable partnerships with and with individuals and their former SUDs and their relatives, clinicians, policy makers, payers, and advocates. producing evidence, among other things, by fully sharing the findings of the research with the communities involved. Systems established for clinical trials often do not use community resources and partnerships. Developing and implementing collaborative interventions with communities can often lead to effective approaches to underestimated groups that are left out of research and policy decisions.
Fourthly, it will be essential to diversify the scientific working group, which will require a multifaceted approach with the participation of funders, professional bodies and teaching and research organizations. This approach could include hiring candidates from under-represented groups for training opportunities, strengthening partnerships with organizations and scientific organizations serving these groups, and establishing grant programs that facilitate the entry of researchers from different backgrounds.
Finally, SUD-related results cannot be ruled out if researchers do not measure the impact of policies and interventions on equity. Researchers may be able to identify the factors that have the greatest impact on different outcomes to ensure that policies and interventions address these variables. They should also take into account the complex nature of inequalities in order to avoid attributing the results associated with systemic inequalities to inherent inequalities by race or ethnic group, which would exacerbate systemic bias. Research can enroll disproportionate numbers of patients with a variety of coexistence conditions and assess the effects of these conditions on SUD-related health outcomes in order to better address the problems affecting underprivileged populations. To ensure that scarce resources are channeled into equity-friendly interventions, researchers who want to tailor their interventions to the needs of specific racial and ethnic groups can compare their effects with and without adaptations, and determine if adaptation is necessary.
Applying an equity lens to efforts to address the growing epidemic of overdose and other SUD-related damage is essential to eliminating racial and ethnic inequalities and improving health outcomes. This approach can also serve as a framework for reducing inequalities in other patient populations. Considering the contribution of the community in the design of the research; patient, community, payer, and policy maker participation; and re-examining opportunities for learning outcomes and measurement strategies can transform our approaches to equity and ultimately improve health and well-being in historically underestimated groups.