LatinX harm reduction capital, medication for opioid use disorder, and nonfatal overdose: A structural equation model analysis among people who use drugs in Massachusetts

Abstract

Background: We introduce the concept of harm reduction capital (HRCap) as the combination of knowledge, resources, and skills related to substance use risk reduction, which we hypothesize to predict MOUD use and opioid overdose. In this study, we explored the interrelationships between ethnicity, HRCap, nonfatal overdose, and MOUD use among PWUD.

Methods: Between 2017 and 2019, people who currently or in the past used opioids and who lived in Massachusetts completed a one-time survey on substance use history, treatment experiences, and use of harm reduction services. We fit first-order measurement constructs for positive and negative HRCap (facilitators and barriers). We used generalized structural equation models to examine the inter-relationships of the latent constructs with LatinX self-identification, past year overdose, and current use of MOUD.

Results: HRCap barriers were positively associated with past-year overdose (b=2.6, p<0.05), and LatinX self-identification was inversely associated with HRCap facilitators (b=-0.49, p<0.05). There was no association between overdose in the past year and the current use of MOUD. LatinX self-identification was positively associated with last year methadone treatment (b=0.89, p<0.05) but negatively associated with last year buprenorphine treatment (b=-0.68, p<0.07). Latinx PWUD reported lower positive HRCap than white non-LatinX PWUD and had differential utilization of MOUD.

Conclusion: Our findings indicate that a recent overdose was not associated with the current use of MOUD, highlighting a severe gap in treatment utilization among individuals at the highest risk. The concept of HRCap and its use in the model highlight substance use treatment differences, opportunities for intervention, and empowerment.

Keywords: Harm reduction capital; Medication for opioid use disorder; Opioids; Overdose.

Fig. 1.

Conceptualization of Harm Reduction Captial and its association with medication for opioid use disorder and history of nonfatal opioid overdose.

Fig. 2.

Structural equation model: Harm reduction capital and its association with current use of medication for opioid use disorder (either methadone or buprenorphine), history of nonfatal opioid overdose, and ethnicity. (n = 401, BIC: 5266.9, RMSEA (from secondary analysis): 0.059).

Fig. 3.

Structural equation model: Harm reduction capital and its association with current use of buprenorphine, history of nonfatal opioid overdose, and ethnicity. (n = 426, BIC: 5419.9, RMSEA (from secondary analysis): 0.06).

Fig. 4.

Structural equation model: Harm reduction capital and its association with current use of methadone, history of nonfatal opioid overdose, and ethnicity. (n = 402, BIC: 5225.8, RMSEA (from secondary analysis): 0.057).