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Review
. 2023 Oct 20;20(20):6950.
doi: 10.3390/ijerph20206950.

A Diagram of the Social-Ecological Conditions of Opioid Misuse and Overdose

Benjamin R Brady  1   2 , Ehmer A Taj  1 , Elena Cameron  1 , Aaron M Yoder  3   4 , Jennifer S De La Rosa  1   5
Affiliations
Review

A Diagram of the Social-Ecological Conditions of Opioid Misuse and Overdose

Benjamin R Brady et al. Int J Environ Res Public Health. .

Abstract

The United States is experiencing a crisis of opioid misuse and overdose. To understand the underlying factors, researchers have begun looking upstream to identify social and structural determinants. However, no study has yet aggregated these into a comprehensive ecology of opioid overdose. We scoped 68 literature sources and compiled a master list of opioid misuse and overdose conditions. We grouped the conditions and used the Social Ecological Model to organize them into a diagram. We reviewed the diagram with nine subject matter experts (SMEs) who provided feedback on its content, design, and usefulness. From a literature search and SME interviews, we identified 80 unique conditions of opioid overdose and grouped them into 16 categories. In the final diagram, we incorporated 40 SME-recommended changes. In commenting on the diagram's usefulness, SMEs explained that the diagram could improve intervention planning by demonstrating the complexity of opioid overdose and highlighting structural factors. However, care is required to strike a balance between comprehensiveness and legibility. Multiple design formats may be useful, depending on the communication purpose and audience. This ecological diagram offers a visual perspective of the conditions of opioid overdose.

Keywords: opioid use disorder; overdose; social determinants; social ecology.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Literature selection and inclusion criteria.
Figure 2
Figure 2
Opioid use, misuse, and overdose condition categories.
Figure 3
Figure 3
Opioid use, misuse, and overdose conditions categorized by social ecological level.
See this image and copyright information in PMC

References

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MeSH terms

Substances