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Diversity & Inclusion Disparities in Opioid Overdose
Disparities in Opioid Overdose
By Jonathan Berger, MPH, and Alex F. Manini, MD, MS
Drug overdose fatalities involving opioids continued to rise in 2021 with 71,238 deaths in the United States. The emergency department (ED) serves as a critical safety-net and window of opportunity for this population and must be integrated into multidisciplinary research aimed at finding solutions for those living with opioid use disorder (OUD). Furthermore, certain populations face higher burdens of OUD risk, such as American Indian, Alaskan Native, and non-Hispanic Black individuals. However, one potential high-risk population that intersects all groups is the lesbian, gay, bisexual, trans, queer+ (LGBTQ+) community.
There remains a substantial literature gap in examining the burden of overdose faced by the LGBTQ+ community. There needs to be more quantitative and qualitative research exploring behaviors, patterns, outcomes, and interventions targeted at LGBTQ+ folks living with OUD. In 2019, just before the global COVID-19 outbreak, Canadian researchers issued a call for action on overdose among LGBTQ+ people in North America. Interdisciplinary solutions are needed to provide support, alleviate “While most OUD prevention research currently focuses on integrating behavioral and primary health care, a third specialty should be considered more thoroughly: emergency medicine.”
DIVERSITY & INCLUSION
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suffering, and to address the root causes of addiction within the LGBTQ+ community.
While most OUD prevention research currently focuses on integrating behavioral and primary health care, a third specialty should be considered more thoroughly: emergency medicine. Especially because the volume of patients in need of emergency care for OUD consistently overwhelms the ED. Perhaps upstream solutions targeting psychosocial stressors, housing instability, access to preventative health services, and systemic mistreatment of marginalized communities can reduce this burden; however, targeting “downstream” bottlenecks in emergency care could improve opportunities for sustainable progress, enhance access to resources, and optimize care.
It is important to note that LGBTQ+ people of color (POC) are further subject to additional social stressors stemming from experiences of racism, heterosexism, and/or cissexism. Starting from a young age, LGBTQ+ people live everyday with discrimination, marginalization, and victimization based on their sexual and gender minority status. The Fenway Institute in Boston recently reported on the higher prevalence of substance use disorders amongst LGBTQ+ persons. The higher prevalence of OUD, among LGBTQ+ people should be considered within a model of minority stress. Given minority stress theory’s emphasis on the detrimental impact of cumulative stress on well-being, researchers have posited that these multiple experiences of social stressors may leave LGBTQ+ POC especially vulnerable to adverse health outcomes, such as OUD and overdose.
Leveraging the ED could help alleviate burdens of OUD for LGBTQ+ populations. To make way for solutions to drive improved outcomes, we must bolster the body of evidence-based research that examines interdisciplinary interventions at the intersection of OUD in the LGBTQ+ community in the ED. Optimizing emergency care will not only improve outcomes for those most burdened by OUD, but will also help to alleviate the tension placed on our most vulnerable health care resource, the ED. This vision will require additional resources and funding to examine the specific characteristics and health care utilization patterns of the LGBTQ+ community who engage in opioid use and remain at risk for overdose. Unless this data is gathered, published, and disseminated, this population will continue to face elevated adverse health outcomes as compared to their cisheterosexual counterparts.
ABOUT THE AUTHORS
Jonathan Berger is a toxicology research project manager at the Icahn School of Medicine at Mount Sinai in the department of emergency medicine. He received his MPH in healthcare policy and management from Columbia University Mailman School of Public Health.
Dr. Manini is a professor of emergency medicine at the Icahn School of Medicine at Mount Sinai and practices clinically at Elmhurst Hospital Center. Dr. Manini is director of the toxicology research core in the emergency medicine research division and associate program director of the T32 training program focused on emergency care research.
