Health Equity in the Response to Drug Overdose
Fatal drug overdoses have long been a public health crisis in the United States. From 1999 – 2018, nearly 450,000 people died from overdoses in the United States.[i] In 2019, there were more than 70,000 drug overdose deaths. While public health efforts have brought attention to drug addiction as a disease and have improved access to substance use disorder (SUD) treatment and services, many health inequities have not been addressed.
The Division of Overdose Prevention (DOP) and National Center for Injury Prevention and Control (NCIPC) at the Centers for Disease Control and Prevention (CDC) partnered with the National Association of County and City Health Officials (NACCHO) on a project to investigate the literature available on this topic, as well as tools and resources which could provide guidance for health departments on addressing drug overdose through the use of a health equity lens.
Through this review, it was concluded that more attention to upstream factors of drug overdose health inequities would likely have a positive effect on downstream factors including overdose. It was, also, found that most sources focused primarily on inequities along racial and ethnic lines. In addition to race and ethnicity more attention to health inequities within and across populations, including but not limited to LGBTQIA+, adolescent, aging, sex and gender-based, and immigrant populations is also warranted. Thus, the resources and tools listed on this page have been provided to help health departments consider root causes and the interconnected system of upstream inequities when addressing drug overdoses in their jurisdictions.
Equity Considerations for Local Health Departments on Opioid Settlement Funds Checklist
The Legal Action Center (LAC), with the support of the National Association of County and City Health Officials (NACCHO), has crafted the Equity Considerations for Local Health Departments on Opioid Settlement Funds Checklist. This valuable resource aims to guide county and city health officials through decision-making for the allocation and distribution of opioid settlement funds, highlighting health equity principles such as community engagement, oversight and accountability, and cultural humility. The resource is divided into five critical sections, each offering strategies for LHDs to improve access to services; remove funding constraints; tailor support for priority communities; collect data for the promotion of health equity; and community education. For any questions about this checklist or other resources related to integrating health equity into overdose prevention, please contact us at [email protected].
The Health Equity in the Response to Drug Overdose Online Training is new virtual learning resource developed by Health Research Toolbox (HEART) and available through our NACCHO University platform.
The Health Equity in the Response to Drug Overdose Online Training is a 12-module, free online course designed to guide health practitioners in their integration of fundamental health equity concepts and methodologies into their local drug overdose prevention and response efforts. Through the course of this learner-centered training, participants will walk through key health equity concepts and methodologies while engaging in a range of interactive features, from practical exercises and worksheets to short videos and knowledge checks.
To learn more and register for the course, please visit NACCHO University and access the course here. If you have any questions about the course or how to engage, please reach out to Jasmine Akuffo at [email protected].
With support from the Division of Overdose Prevention (DOP) in the National Center for Injury Prevention and Control (NCIPC) at the Centers for Disease Control and Prevention (CDC), the National Association of County and City Health Officials (NACCHO) has released the Integrating Health Equity Into Overdose Prevention and Response: An Environmental Scan, designed to identify existing barriers and facilitators local and state health departments face to advancing health equity in their overdose prevention or response efforts. This environmental scan captures knowledge gained through high-level key informant interviews with state and local health departments to identify current activities, gaps, and innovative strategies currently being leveraged to address health equity and the social determinants of health within drug overdose prevention and response. State and local health departments can use this resource to inform the development of strategies, trainings, and other resources that can better combat existing health inequities in drug overdose.
| Title | Type | Level | Source | Description |
|---|---|---|---|---|
| PolicyLink Health Equity | Webpage | National | Policy Link | A guide developed to support health equity leaders seeking to transform public health institutions and embed health equity into their day-to-day practices. |
| Promoting Health Equity: A Resource to Help Communities Address Social Determinants of Health | Resource repository | National | Centers for Disease Control and Prevention | A workbook for public health practitioners and partners interested in addressing social determinants of health. |
| Local & regional Government Alliance on Racial Equity: Tools & Resources | Webpage | National | Racial Equity Alliance | A resource outlining tools for racial equity that capture an overall approach to integrating racial equity into routine decision making. |
| Reducing Harms: Recognizing and Responding to Opioid Overdoses in Your Organization | Report | International | Canadian Mental Health Association | A resource equipping community service providers with current, accessible and relevant information that can be used to inform and develop an opioid overdose protocol. |
| Advisory: Low Barrier Models of Care for Substance Use Disorders | Advisory/ Guidance | National | Substance Abuse and Mental Health Services Administration (SAMHSA) | This guidance discusses an essential approach to addressing substance use disorders by minimizing barriers and promoting equitable access to care. It outlines principles of low barrier care, emphasizing its potential to overcome access gaps and engage individuals in treatment. |
| Opioid Misuse Tool: Drug Overdose Deaths in the United States | Tool | National | NORC at the University of Chicago | This mapping tool illustrates the relationship between community and population demographics and fata drug overdoses in the United States. Insights derived from this tool can inform resources and interventions. |
| Syringe Service Program Community Advisory Boards: A Framework | Framework | Local | Johns Hopkins Bloomberg School of Public Health | This framework for syringe service programs (SSPs) guides program leaders and community members to establish effective community advisory boards (CABs). It outlines the importance of meaningful involvement of PWUD, benefits and challenges of CABs, measuring success and impact, and much more. |
| The Opioid Crisis: A Contextual, Social-Ecological Framework | Framework | National | BMC Health Research Policy and Systems | This social-ecological framework considers multivariable risk factors across individual, interpersonal, communal, and societal levels, highlights the complexity of the crisis, and emphasizes the need for a comprehensive approach to prevention and treatment. |
| Title | Type | Level | Source | Description |
|---|---|---|---|---|
| Achieving Health Equity | Resource repository | National | Robert Wood Johnson Foundation | A repository built to provide resources on how entities can work towards achieving health equity. |
| Adverse Community Experiences and Reslience: A Framework for Addressing and Preventing Community Trauma | Framework/ Guidance | National | Prevention Institute | This report offers a groundbreaking framework for understanding the relationship between community trauma and violence. |
| Michigan Safer Opioid Prescribing Toolkit: Health Disparities in Prescribing Opioids | Resource repository | State | Michigan Safer Opioid Prescribing Toolkit | A comprehensive resource hub launched in conjuction with University of Michigan providing resources for clinical practice. |
| National Overdose Prevention Network: Health Equity Tool | Guideline/Framework | National | National Overdose Prevention Network | A health equity tool developed by the National Overdose Prevention Network to organize organizational responses to health equity challenges. |
| Minnesota Department of Health: Social Determinants of Substance Use & Overdose Prevention | Webpage | State | Minnesota Department of Health | A webpage from the Minnesota Department of Health providing background on social determinants of health, social-ecologic model (SEM) mapping, and health inequities in relation to overdose prevention. |
| Health Equity Frameworks to Inform Responses to Opioid Overdose | Report | International | Canadian Institute for Substance Use Research (CISUR) | A systematic scoping review identifying and describing literature which use "a health equity-oriented approach for preventing and reducing the harms of stigma or overdose for people who use illicit drugs or misuse prescription opioids." (Bruce et al., 2021) |
| The Health Equity Framework: A Science and Justice-Based Model for Public Health Researchers and Practitioners | Framework / Guidance | National | ETR | In this article, ETR describes their "science- and justice-based framework for promoting health equity designed for researchers and practitioners working across public health and social science fields." (Peterson et al. 2020) |
| Protecting Our Communities Toolkit | Toolkit | National | Drug Policy Alliance | This toolkit provides advocates with data on recent trends in health, houselessness, crime, and enforcement; recommendations to address intertwined crises through health-centered policy responses; and information on how to fund health-centered responses. |
| Promoting Health Equity - Harm Reduction: A Tool for Primary Health Care Organization and Providers | Tool/ Guidance | Local | EQUIP Health Care | This is a tool for primary health care organizations and providers working with individuals to move their practice toward equity-oriented harm reduction. This tool is intended for healthcare audiences and was developed by a Canadian organization. |
| Rate Your Organization: A Discussion Tool Harm Reduction and Reducing Substance Use Stigma | Tool | Local | EQUIP Health Care | This worksheet is a discussion tool to assess your own organization, agency, or setting with the goal to support dialogue and action among all staff to optimize capacity and action for harm reduction and reducing substance use stigma. This tool is intended for healthcare audiences and was developed by a Canadian organization. |
| Title | Type | Level | Source | Description |
|---|---|---|---|---|
| Frameworks Institute: Equity | Resource repository | National | Frameworks | A resource repository providing information on issues ranging from justice reform, to residential segregation, and health disparities. |
| Prevention Institute: Health Equity & Racial Justice | Webpage | National | Prevention Institute | The Prevention Institute developed practical, free-to-use tools to guide practitioners, advocates, and policymakers in planning and implementing prevention strategies. |
| Office of Health Equity and Minority Health: Michigan | Webpage | State | Michigan Department of Health & Human Services | The Michigan Office of Equity and Minority Health supports and initiates programs, policies, and applied research to address social determinants of health that contribute to health inequities for racial and ethnic minority populations in Michigan. |
| Tamarack Institute: Resource Library | Resource repository | International | Tamarack Institute | The Tamarack Institute develops and supports collaborative strategies that engage citizens and institutions to solve major community issues across Canada and beyond. |
| Health Equity: A Guide to Language, Narrative and Concepts | Guide | National | American Medical Association | This guide was prepared by the AMA and AAMC. |
| Building Power to Black Health & Wellness | Toolkit | Local | Black Harm Reduction Network & Legal Action Center | This toolkit includes guidance highlighting the pressing issues related to overdose within Black communities. It underscores the importance of aligning harm reduction efforts with community values, emphasizing the crucial role of location and advocacy in raising awareness, and garnering support for harm reduction initiatives. |
| Research to Move Policy - Using Evidence to Advance Health Equity for Substance Use Disorders | Article | National | The New England Journal of Medicine | This article discusses racial and ethnic disparities in the treatment of substance use disorders in the United States and potential approaches to address the overdose epidemic, address social determinants of health, and promote health equity. |
| National Council for Mental Wellbeing: Advocacy Handbook | Handbook/ Tool | Local | National Council for Mental Wellbeing | This handbook includes tips, tricks, and downloadable templates for becoming a mental health and substance use treatment advocate in your community. |
https://www.cdc.gov/nchs/data/databriefs/db394-H.pdf Centers for Disease Control and Prevention. Drug Overdose Deaths in the United States, 1999–2019. Retrieved March 31, 2020, from https://www.cdc.gov/nchs/data/databriefs/db394-H.pdf.
Centers for Disease Control and Prevention. Drug Overdose Deaths in the United States, 1999-2018. Retrieved September 1, 2020, from https://www.cdc.gov/nchs/products/databriefs/db356.htm.
Community Health Program
Stacy Stanford
Senior Director, Overdose, Injury, and Violence Prevention
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Community Health Program
Emily Winkelstein
Director, Overdose Prevention
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Public Health Infrastructure and Systems
Jasmine Akuffo
Senior Program Analyst, Health Equity
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Community Health Program
Drue Foster
Program Analyst, Overdose Prevention
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Community Health Program
Jessica Vines
Senior Program Assistant, Overdose Prevention
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