Another #harmred22 tweet storm this one about RACK study (Rapid Assessment of Consumer Knowledge - brief, mixed methods research approach to gain insight into local challenges and responses to the opioid crisis as shared by people who use drugs) in MA
Rate of opioid overdose deaths for Hispanics has increased dramatically in MA compared with national rates.
For Hispanic/Latinx and African Americans, risk of overdose heavily tied to fentanyl and cocaine supply - contamination, inexperienced exposure for folks primarily using stimulants.
For older African American adults, lots of difficulties getting adequate chronic pain care especially if OUD and non-rx pills with fentanyl also bit contributed to overdose risk.
Solutions: structural interventions are critical especially decarceration, ensuring medication tx in criminal Justice communities, etc. need to engage “non traditional partners (mutual aid, barbershops, bodegas, churches, housing) in harm reduction & overdose prevention
Among African Americans:
Highest risk: cocaine use without intention of fentanyl use, occasional fentanyl use to “come down” from cocaine.
Perception that sniffing/smoking is fully protective (it’s not if people don’t have any tolerance)
Highest risk: cocaine use without intention of fentanyl use, occasional fentanyl use to “come down” from cocaine.
Perception that sniffing/smoking is fully protective (it’s not if people don’t have any tolerance)
Lower risk: cocaine use on MOUD, “speedballing”, using cocaine after fentanyl use
Drug market reorganization, changes in drug distribution pathways ==> intensified market completion, contamination of powders/pills, more frequent distribution errors
Why the huge increase in African American deaths (24 excess deaths) in one year (?2017?)
One analogue (cyclopropylfentanyl) associated with vast majority of deaths (19), most of them in 4 mo period in one neighborhood in Boston - likely sold as pressed pills. A poisoning.
One analogue (cyclopropylfentanyl) associated with vast majority of deaths (19), most of them in 4 mo period in one neighborhood in Boston - likely sold as pressed pills. A poisoning.
Current approaches good but leave many people of color in MA out of adequate overdose prevention.
Lack of saturation of naloxone among stimulant users or “dabblers”, & understanding of why people need it. Variable awareness of fentanyl.
Lack of saturation of naloxone among stimulant users or “dabblers”, & understanding of why people need it. Variable awareness of fentanyl.
Hesitation to call 911 & include police (or ICE) plays a role in overdose response.
We need structural interventions:
- representation & cultural humility in health care
- ensure equity/access information MOUD
- overdose prevention interventions that people can use alone in homes
- engage dealers/suppliers in harm reduction education
- representation & cultural humility in health care
- ensure equity/access information MOUD
- overdose prevention interventions that people can use alone in homes
- engage dealers/suppliers in harm reduction education
• • •
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