Predicting Opioid Use Outcomes in Minoritized Communities

Machine learning algorithms can sometimes exacerbate health disparities based on ethnicity, gender, and other factors. There has been limited work at exploring potential biases within algorithms deployed on a small scale, and/or within minoritized communities. Understanding the nature of potential biases may improve the prediction of various health outcomes. As a case study, we used data from a sample of 539 young adults from minoritized communities who engaged in nonmedical use of prescription opioids and/or heroin. We addressed the indicated issues through the following contributions: 1) Using machine learning techniques, we predicted a range of opioid use outcomes for participants in our dataset; 2) We assessed if algorithms trained only on a majority sub-sample (e.g., Non-Hispanic/Latino, male), could accurately predict opioid use outcomes for a minoritized sub-sample (e.g., Latino, female). Results indicated that models trained on a random sample of our data could predict a range of opioid use outcomes with high precision. However, we noted a decrease in precision when we trained our models on data from a majority sub-sample, and tested these models on a minoritized sub-sample. We posit that a range of cultural factors and systemic forms of discrimination are not captured by data from majority sub-samples. Broadly, for predictions to be valid, models should be trained on data that includes adequate representation of the groups of people about whom predictions will be made. Stakeholders may utilize our findings to mitigate biases in models for predicting opioid use outcomes within minoritized communities

Syndemic factors associated with non-fatal overdose among young opioid users in New York City

IntroductionRates of illicit opioid use are particularly high among young adults, yet research on overdose experience and factors associated with overdose in this population remains limited. This study examines the experiences and correlates of non-fatal overdose among young adults using illicit opioids in New York City (NYC).Methods539 participants were recruited via Respondent-Driven Sampling in 2014-2016. Eligibility criteria included: aged 18–29 years old; current residence in NYC; and nonmedical prescription opioid (PO) use and/or heroin use in the past 30 days. Participants completed structured interviews to assess their socio-demographics, drug use trajectories, current substance use and lifetime and most recent overdose experiences, and were tested on-site for hepatitis C virus (HCV) antibodies.Results43.9% of participants reported lifetime overdose experience; of these, 58.8% had experienced two or more overdose events. The majority of participants’ most recent overdoses (63.5%) were due to polysubstance use. In bivariable analyses, after RDS adjustment, having ever overdosed was correlated with: household income of >$100,00 growing up (vs.$51,000-100,000); lifetime homelessness; HCV antibody-positive status; lifetime engagement in regular nonmedical benzodiazepine use, regular heroin injection and regular PO injection; and using a non-sterile syringe in the past 12 months. Multivariable logistic regression identified childhood household income >$100,00 (AOR=1.88), HCV-positive status (AOR=2.64), benzodiazepine use (AOR=2.15), PO injection (AOR=1.96) and non-sterile syringe use (AOR=1.70) as significant independent correlates of lifetime overdose. A multivariable model with multiple overdoses (vs. one) found only lifetime regular heroin use and PO injection to be strong correlates.DiscussionResults indicate a high prevalence of lifetime and repeated overdose among opioid-using young adults in NYC, highlighting a need for intensified overdose prevention efforts for this population. The strong associations of HCV and indices of polydrug use with overdose suggest that prevention efforts should address the complex risk environment in which overdose occurs, attending to the overlapping nature of disease-related risk behavior and overdose risk behavior among young people who inject opioids. Overdose prevention efforts tailored for this group may find it useful to adopt a syndemic conception of overdose that understands such events as resulting from multiple, and often interrelated, risk factors

Hepatitis C virus risk among young people who inject drugs

BackgroundInjection drug use (IDU) is the leading risk factor for hepatitis C virus (HCV) transmission in the U.S. While the general risk factors for HCV transmission are known, there is limited work on how these factors interact and impact young people who inject drugs (YPWID).MethodsProject data were drawn from a study of 539 New York City (NYC) residents ages 18-29 who were recruited via Respondent-Driven Sampling and, reported past-month non-medical use of prescription opioids and/or heroin. Analyses are based on a subsample of 337 (62%) who reported injecting any drug in the past 12 months. All variables were assessed via self-report, except HCV status, which was established via rapid antibody testing. Integrating the observed statistical associations with extant literature on HCV risk, we also developed a qualitative system dynamics (SD) model to use as a supplemental data visualization tool to explore plausible pathways and interactions among key risk and protective factors for HCV.ResultsResults showed a 31% HCV antibody prevalence with an overall incidence of 10 per 100 person-years. HCV status was independently correlated with having shared cookers with two or more people (AOR = 2.17); injected drugs 4–6 years (AOR = 2.49) and 7 or more years (AOR = 4.95); lifetime homelessness (AOR = 2.52); and having been incarcerated two or more times (AOR = 1.99). These outcomes along with the extant literature on HCV risk were used to develop the qualitative SD model, which describes a causal hypothesis around non-linearities and feedback loop structures underlying the spread of HCV among YPWID.ConclusionsDespite ongoing harm reduction efforts, close to a third of YPWID in the community sample have been exposed to HCV, have risks for injection drug use, and face challenges with structural factors that may be preventing adequate intervention. The qualitative SD model explores these issues and contributes to a better understanding of how these various risk factors interact and what policies could potentially be effective in reducing HCV infections

The social production of substance abuse and HIV/HCV risk: an exploratory study of opioid-using immigrants from the former Soviet Union living in New York City

<p>Abstract</p> <p>Background</p> <p>Several former Soviet countries have witnessed the rapid emergence of major epidemics of injection drug use (IDU) and associated HIV/HCV, suggesting that immigrants from the former Soviet Union (FSU) may be at heightened risk for similar problems. This exploratory study examines substance use patterns among the understudied population of opioid-using FSU immigrants in the U.S., as well as social contextual factors that may increase these immigrants' susceptibility to opioid abuse and HIV/HCV infection.</p> <p>Methods</p> <p>In-depth interviews were conducted with 10 FSU immigrants living in New York City who initiated opioid use in adolescence or young adulthood, and with 6 drug treatment providers working with this population. Informed by a grounded theory approach, interview transcripts were inductively coded and analyzed to identify key themes.</p> <p>Results</p> <p>The "trauma" of the immigration/acculturation experience was emphasized by participants as playing a critical role in motivating opioid use. Interview data suggest that substance use patterns formed in the high-risk environment of the FSU may persist as behavioral norms within New York City FSU immigrant communities - including a predilection for heroin use among youth, a high prevalence of injection, and a tolerance for syringe sharing within substance-using peer networks. Multiple levels of social context may reproduce FSU immigrants' vulnerability to substance abuse and disease such as: peer-based interactional contexts in which participants typically used opioids; community workplace settings in which some participants were introduced to and obtained opioids; and cultural norms, with roots in Soviet-era social policies, stigmatizing substance abuse which may contribute to immigrants' reluctance to seek disease prevention and drug treatment services.</p> <p>Conclusion</p> <p>Several behavioral and contextual factors appear to increase FSU immigrants' risk for opioid abuse, IDU and infectious disease. Further research on opioid-using FSU immigrants is warranted and may help prevent increases in HIV/HCV prevalence from occurring within these communities.</p

Sex, drugs, and disease: A Gramscian analysis of AIDS discourse in the American media

This paper examines the ideological diversity evidenced in discourse about AIDS in the popular American print media within a framework of Gramscian concepts of hegemony and counter-hegemony. By identifying several "discourses" on AIDS, I explore how they are distinct, what they reveal of the underlying ideologies of their promulgators and to what extent they overlap. An extended discussion of specific metaphors and rhetorical strategies characteristic of a hegemonic discourse, propagated by certain governmental agencies and mainstream news magazines, is contrasted with alternative discursive strategies employed by the gay/lesbian press, the liberal press and the Catholic Church. Moreover, areas of ideological tension within the hegemonic discourse are revealed, as well as points of intersection between "separate" discourses. Finally, the ideological complexity manifest in this discursive field is brought to bear on Gramscian theory which is found to be somewhat limiting in its implication of a dualistic opposition between domination and resistance

AIDS and identity construction: The use of narratives of self-transformation among clients of AIDS service organizations

The central objective of this paper is to investigate how the experience of living with HIV/AIDS in the U.S. impacts an individual's sense of identity and to what extent this identity is influenced by the institutional ideologies of AIDS service organizations and the "dominant discourse" of AIDS these organizations help produce. My analysis is based upon three years of participant-observation at Gay Men's Health Crisis (GMHC), a major AIDS service organization in New York City, as well as in-depth semi-structured interviews with 34 HIV positive individuals, all of whom are clients of either GMHC or another AIDS-related service agency in New York. In addition, I juxtapose the interview-derived speech data of HIVers with an examination of various kinds of textual material about AIDS--written texts that constitute what I characterize as a "dominant discourse" of AIDS. As my primary unit of analysis, I examine the narratives of self-transformation articulated by interviewees, stories that are quite literally about identity reconstruction. Through these narratives, HIV positive individuals construct their HIV diagnosis as a significant turning point in their lives, interpreting this event as an opportunity to refashion themselves into "better" people and to begin their lives anew. Narratives of self-transformation function to rehabilitate HIVers' identities since the new identities many interviewees claim to have achieved after their HIV-impelled journeys of self-reinvention are crafted in accordance with the normative model of HIVer identity established in the dominant discourse

Consumers’ Experiences in Dual Focus Mutual Aid for Co-occurring Substance Use and Mental Health Disorders

Mutual aid fellowships have been shown to improve outcomes for those with co-occurring substance use and mental illness disorders. Processes associated with usefulness include helper therapy (the assumption of a helping role to foster commitment) and reciprocal learning (the sharing of problems and solutions among members). The present qualitative investigation used focus groups comprised a subset of participants in Double Trouble in Recovery (DTR), a 12-step mutual aid group for those with co-occurring disorders, to gather their subjective perceptions of the groups. Participants emphasized that in linking them to others with similar problems, the DTR groups played a vital emotional role in their lives and provided a needed venue for information sharing that might have been otherwise unavailable