Prevalence and correlates of experiencing drug-related discrimination among people who use drugs presenting at emergency department at high risk of opioid overdose

Objectives: Our objective is to determine if specific sociodemographic characteristics were associated with perceived drug-related discrimination among people who use drugs (PWUD) presenting for care in the emergency department (ED). Methods: We conducted a secondary analysis of data from the Navigator trial, a randomized control trial of two behavioral interventions in the ED for people at risk of an opioid overdose. Participants included adult patients presenting to two Rhode Island EDs. Eligible participants included those high risk for an opioid overdose, resided or received most of their healthcare in Rhode Island, and were able to provide consent. The primary outcome of this analysis was self-reported feelings of drug-related discrimination by the medical community. The independent variables of interest included race/ethnicity, gender identity, and sexual orientation. Log-binomial multivariable regression models were constructed with all three independent variables of interest and a selection of sociodemographic covariates. Results: Of 620 eligible participants, 251 (40.5%) reported ever experiencing drug-related discrimination in their lifetime. In the adjusted model, participants who identified as women and participants who identified as LGBQIA+ were more likely to report experiencing drug-related discrimination from the medical community in EDs. Racial/ethnic minority groups were less likely than White (non-Hispanic) participants to report drug-related discrimination. Discussion: In this study population, White participants reported more drug-related discrimination than their minority counterparts, although female and LGBQIA+ patients reported more discrimination. Future studies should further assess the significance of these intersecting identities on self-reported discrimination. This knowledge could improve ED-based interventions, policies, and services for PWUD

Comparing projected fatal overdose outcomes and costs of strategies to expand community-based distribution of naloxone in Rhode Island.

Importance: In 2021, the state of Rhode Island distributed 10 000 additional naloxone kits compared with the prior year through partnerships with community-based organizations. Question: What community-based naloxone distribution strategies would be the most effective and efficient in preventing opioid overdose deaths? Findings: In this decision analytical model study evaluating the distribution of 10 000 additional naloxone kits annually in Rhode Island, the strategy focusing on distribution of naloxone according to geographic need to people who inject drugs resulted in the best outcomes at the lowest cost, averting an estimated 25.3% of opioid overdose deaths at an incremental cost of $27 312 per opioid overdose death averted. Meaning: This study suggests that expanding naloxone distribution to people at highest risk for opioid overdose should be prioritized and that redirecting spatial distribution of naloxone to areas with the greatest need will improve both effectiveness and efficiency and reduce geospatial health inequality