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. 2020 Sep 1:214:108127.
doi: 10.1016/j.drugalcdep.2020.108127. Epub 2020 Jun 20.

Socioeconomic marginalization and opioid-related overdose: A systematic review

Jenna van Draanen  1 , Christie Tsang  2 , Sanjana Mitra  3 , Mohammad Karamouzian  4 , Lindsey Richardson  5
Affiliations

Socioeconomic marginalization and opioid-related overdose: A systematic review

Jenna van Draanen et al. Drug Alcohol Depend. .

Abstract

Background: Socioeconomic marginalization (SEM) is an important but under-explored determinant of opioid overdose with important implications for health equity and associated public policy initiatives. This systematic review synthesizes evidence on the role of SEM in both fatal and non-fatal overdose among people who use opioids.

Methods: Studies published between January 1, 2000 and March 31, 2018 were identified through searching electronic databases, citations, and by contacting experts. The titles, abstracts, citation information, and descriptor terms of citations were screened by two team members. Data were synthesized using the lumping technique.

Results: A total of 37 studies met inclusion criteria and were included in the review, with 34 of 37 finding a significant association between at least one socioeconomic factor and overdose. The included studies contained variables related to eight socioeconomic factors: criminal justice system involvement, income, employment, social support, health insurance, housing/homelessness, education, and composite measures of socio-economic status. Most studies found associations in the hypothesized direction, whereby increased SEM was associated with a higher rate or increased likelihood of the overdose outcome measured. The review revealed an underdeveloped evidence base.

Conclusions: Nearly all reviewed studies found a connection between a socioeconomic variable and overdose, but more research is needed with an explicit focus on SEM, using robust and nuanced measures that capture multiple dimensions of disadvantage, and collect data over time to better inform decision making around opioid overdose.

Keywords: Drug-related death; Poisoning; Poverty; Socioeconomic status; Toxicity.

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Conflict of interest statement

Declaration of Competing Interest No conflict declared.

Figures

Fig. 1
Fig. 1
PRISMA Flow Diagram.
Fig. 2
Fig. 2
Aggregate Risk of Bias Plot for Observational Cohort and Cross-Sectional Studies.
See this image and copyright information in PMC

References

    1. Allen J., Balfour R., Bell R., Marmot M. Social determinants of mental health. Int. Rev. Psychiatry. 2014;26(4):392–407. - PubMed
    1. Amundsen E.J. Drug-related causes of death: socioeconomic and demographic characteristics of the deceased. Scand. J. Public Health. 2015;43(6):571–579. - PubMed
    1. Binswanger I., Stern M.F., Elmore J.G. ’Release from prison–a high risk of death for former inmates’: author’s reply. N. Engl. J. Med. 2007;356(17):1786–1787. - PMC - PubMed
    1. Bohnert A.S.B., Nandi A., Tracy M., Cerda M., Tardifff K.J., Vlahov D., Galea S. Policing and risk of overdose mortality in urban neighborhoods. Drug Alcohol Depend. 2011;113(1):62–68. - PMC - PubMed
    1. Brinkley-Rubinstein L., Macmadu A., Marshall B.D.L., Heise A., Ranapurwala S.I., Rich J.D., Green T.C. Risk of fentanyl-involved overdose among those with past year incarceration: findings from a recent outbreak in 2014 and 2015. Drug Alcohol Depend. 2018;185:189–191. - PubMed

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