Applying Culturally Appropriate Solutions to the Opioid Epidemic
This article is featured in the magazine, A Public Health Perspective on the Opioid Crisis. Download it now.
By Dr. Ebun Ebunlomo, Faculty Member, Public Health, American Public University
The opioid epidemic affects distinct social and cultural groups. According to the Centers for Disease Prevention and Control (CDC), African-Americans experienced the largest relative rate of increase (56.1%) in opioid-involved deaths between 2015 and 2016. There is a broader cultural element contributing to wide-spread addiction within this population and socio-economic elements need to be evaluated in order to help solve this public health crisis.
For example, individuals from different cultural backgrounds tend to identify with different treatment options or interventions, so efforts must be made to apply the culturally appropriate interventions in African-American communities. African-Americans also face distinct stigmas and socio-cultural barriers, which must be taken into account.
Addressing Addiction Issues Among African-Americans
There has always been a lingering concern over substance-use disorders among African-American communities. With respect to sex/gender and age, males aged 25-44 years showed the highest increases of opioid-involved deaths and deaths involving synthetic opioids. In addition, counties in large metropolitan areas experienced the largest absolute increases in deaths with a concentration in eastern states. Based on these data trends, we can extrapolate that African-American males living in metropolitan areas are overrepresented in opioid-involved death statistics.
The recent surge in opioid overdose deaths among African-American males may be partly attributed to the use of fentanyl, a synthetic opioid that is far more potent than heroin but often laced in heroin. Insufficient knowledge about the dose titration of fentanyl is a consequential factor leading to overdose.
Reducing Mistrust of Criminal Justice System
To better provide necessary services to African-Americans suffering from addictions, significant hurdles need to be overcome. First and foremost, the historical perspective of heavy criminalization of drug-related offences in the African-American community must be recognized. African-Americans and whites use drugs at similar rates, but the imprisonment rate of African-Americans for drug charges is almost six times that of whites.
Furthermore, the rise in racially charged interactions with law enforcement and wrongful deaths of minorities in this country ought to be considered when addressing addiction issues, particularly opioid abuse in the United States. This can be done by including racial impact assessments in the implementation of drug-policy proposals, in order to better understand the impact of racial discrimination as a predictor of mental health issues, which then lead to opioid use as a maladaptive coping mechanism.
Law enforcement, policy makers, and community leaders ought to consider culturally appropriate programs that would benefit this population as suggested by current literature. Proposed interventions must seek to clear the air of mistrust that is prevalent among African-American minorities.
One such initiative, From Punishment to Public Health, employs the collaboration of criminal justice officials with clinical and public health professionals to lobby against incarceration for drug offenders and instead push for diversion of offenders to mental health and substance-use treatment programs.
Culturally Appropriate Ways to Address Substance Abuse and Addiction
The CDC has recommended several strategies including harm-reduction services and treatment services for addiction and mental health. However, it is important to take a step back and see how these recommended strategies translate within the most-affected sub-population: African-American males.
Among individuals with low perceived need for treatment, harm-reduction services are a set of policies, programs, and practices that minimize harm from injection drug use. These services include (but are not limited to) needle- and syringe-exchange programs (NEP/SEP) and opioid agonist therapy. Such programs aim to reduce the risk of overdose as well as help prevent the transmission of infections such as HIV, Hepatitis B and C, and others.
Recent studies show a dichotomy of public perception about harm-reduction programs in African-American communities. Some believe it is an acceptable service, while others believe it to be an “inadequate and inappropriate response” because of other contributing factors to substance abuse within this community. In other words, harm-reduction services are treating the symptoms of the issues only while neglecting possible root causes.
Seeking help for substance use disorders depends on a number of factors including perceived need for treatment, availability of treatment services, and cost. It also depends on the cultural competence of providers to recognize and address the root causes of the users’ maladaptive behavior. Providers should ask questions about underlying factors leading to a patient’s behavior rather than assuming that the patient needs to be educated about the consequences of their actions. In other words, is the patient dealing with other issues that could explain why they are using opioids to cope? This is where involving a social worker or other allied health professional comes into play. These factors contribute to the rate of retention in, and completion of, treatment services.
Data suggests that African-American individuals who need illicit drug-use treatment are actually more likely than other racial or ethnic groups to perceive their need for treatment and make an effort to get it. Therefore, making treatment services readily available and cost-accessible will go a long way in tackling this crisis within the African-American community.
Minimizing Stigmas Associated with Treatment
Stigmatization is major deterrent of seeking help and completing treatment. There is a strong need for culturally appropriate stigma-related interventions that promote substance-use treatment programs. One way to better reach the African-American community is through enhanced collaboration with faith-based organizations to offer substance-use prevention and treatment services.
In addition to the stigma associated with seeking “help” for addiction-related treatment (and accompanying mental health needs), poverty and social structures could be potential barriers to the success of local, state, or national initiatives targeting opioid abuse. Opioid abuse is often a symptom of underlying social issues, so developing initiatives to address substance abuse without other programs to alleviate poverty or address discrimination is just like putting a temporary Band-Aid on the issue.
As it is with other public health issues, a multi-level approach factoring in all levels of the socio-ecological framework would be more effective in finding culturally appropriate solutions to such a complex issue as the opioid epidemic in the United States.
Start a public health degree at American Military University.
About the Author: Dr. Ebun Ebunlomo, MPH, MCHES, PHR, is a trained scholar in health promotion and health education, with more than 10 years of experience developing, implementing, and evaluating public health programs in clinical, community, and work-site settings. She previously was an evaluation fellow at the Centers for Disease Control and Prevention in Atlanta. She received her Ph.D. in Health Promotion and Behavioral Sciences, with minors in Epidemiology and Leadership/Management from the University of Texas School of Public Health. To reach the author, email IPSauthor@apus.edu. For more articles featuring insight from industry experts, subscribe to In Public Safety’s bi-monthly newsletter.