= Introductory Paragraph =

This is the second in a pair of related articles on health equity and disproportionality. The first article titled, “Apply a Health Equity Lens,” focused on resources associated with building health equity. <ref>https://www.yoursafesolutions.us/wiki/Apply_a_Health_Equity_Lens</ref> This requires an active commitment to remove obstacles for groups that are more impacted by inequity, and the material below centers on strategies in the field of substance use which are associated with marginalized populations.

= Key Information =

Addressing disparities begins by acknowledging that we are all unique and hold multiple identity lenses. Likewise, as members of different groups within our communities, we experience differences in the screening, diagnosis, treatment, and recovery supports. This is particularly relevant in the historical context of substance use because some groups have been more marginalized or historically underrepresented over others. For example, recent overall statistics demonostrate a 14.5% decline in national overdose deaths for the 12-month period ending June 2024. <ref>https://www.safestates.org/news/687677/CDC-Data-Shows-a-Decline-in-Overdose-Deaths.htm</ref> However, when examining these gains through another lens, it becomes apparent that the recent decrease in the overdose rate is not uniformly distributed. Positive trends predominantly benefit White people.

Increased awareness of disparities and disproportionality impacts the way communities can address substance use in relation to the specific needs of youth, military-connected families, LGBTQI+ individuals, people with disabilities, those with lower socio-economic status, and pregnant people. For example, the majority of pregnant people who use substances who do receive appropriate care and intervention are typically older and White with private health insurance. These people are less likely to be reported to social services, creating significant disparities. People who use substances while pregnant have a great fear and mistrust of medical and treatment providers because of the risk of reporting, prosecution, and infant displacement. Those who are disproportionately impacted by social and health disparites, and do seek treatment, often have little success, as their honesty and vulnerability around their circumstances often leads to criminal reporting or they are unable to find available and affordable treatment programs that meet their specific needs. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> See SAFE Solution article titled, "Expand Perinatal Treatment and Support for People with SUDs" for more information. <ref>https://www.yoursafesolutions.us/wiki/Expand_Perinatal_Treatment_and_Support_for_People_with_SUDs</ref>

The Drug Policy Alliance reports that the US has lost over one million lives to drug overdose during this crisis — yet, even though people of all races and ethnicities use drugs at similar rates, racial and ethnic disparities are evident:

* Black people do not use cocaine at higher rates than other groups, yet the cocaine-related overdose rate for Black people is triple that of White people. Clear racial differentials exist in access to harm reduction programs and medicated-assisted treatment/recovery (MAT/MAR). <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnBlackCommunitiesFactSheet-InDesign-NEW.pdf</ref>
* The overdose rate for Native Americans, between 2021 and 2022, increased by 15% while they decreased for Whites. While national overdose rates in 2020 were comparable for Whites and Native Americans, most recent data reflect Native American rates are almost double the rate for Whites. Some of this difference is attributable to limited resources on tribal lands. A large component is associated with variability in overdose interventions are associated with methamphetamines, versus opioids. In 2022, the national Native American overdose fatality rate associated with methamphetamines was more than double the rate for Whites. <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnNativeCommunitiesFactSheet-InDesign-Interactive.pdf</ref>
* Latinx overdose rates doubled between 2018 and 2022, in large part to the proliferation of Fentanyl. Linguistic barriers which reduce access to prevention and harm reduction programs and are compounded by disparities associated with documentation status. <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnLatinxCommunitiesFactSheet-InDesign-Interactive.pdf</ref>

'''Intersectionality'''

Intersectionality is a complex topic that warrants a full understanding by anyone engaged in social change work. Intersectionality runs deeper than, and should not be confused with, the type of inter-sectoral work found in promoting environmental justice by both environmentalists and social justice activists. Intersectionality describes a method for defining the mix of social identities with more accuracy than single identity formulations allow. For example, everyone is a blend of gender, race, class, and ability categories as opposed to being a type of member in different categories. Intersectionality has become associated with social and political correlations with privilege and marginalization. The term, intersectionality, was coined by Kimberlé Williams Crenshaw in three legal cases in 1989. Although each of the cases were lost, her position has been adopted widely in the social justice community and is often linked with its formative roots in Critical Race Theory. Crenshaw made a case in law suits for black women that this newly defined form of discrimination transcended racial and gender discrimination because black women were being judged in the legal system separately both as women and as members of a minority rather than as black women. In the decades since, the term has become politically controversial, because it has moved outside of the generally agreed upon ''descriptive'' nature of discriminatory patterns to a ''prescriptive'' call to action to address sources of structural power differentials. It has been critiqued both for the scope of change for which intersectional advocates calls and for the difficulty in measuring success in conditions which are inherently multi-variable. <ref>https://www.vox.com/the-highlight/2019/5/20/18542843/intersectionality-conservatism-law-race-gender-discrimination</ref>

'''Coalition Responsibilities When Addressing Disparities'''

Coalitions have a responsibility to work to protect everyone in our communities. The first step in implementing this responsibility is to recognize that history points to long-term patterns of inequity. The next step is to realize the scope and diversity within health inequity. This includes incorporating people with lived experience in the decision making process and implementing trauma-informed approaches. Specific recommendations for practicing cultural competence and humility and for applying a health equity lens in strategy planning are detailed in the section titled “Building Capacity for Health Equity” within the SAFE Solution article on Health Equity. <ref>https://www.yoursafesolutions.us/wiki/Apply_a_Health_Equity_Lens</ref>

In addition to the statistics on racial and ethnic disparities detailed above, there are several constituencies within communities for which substance use statistics are less documented. For example, collection of data on the transgender and people questioning their gender identity have been more difficult to collect, particularly for youth. However, limited data have been collected by SAMHSA in its annual surveys on people who identify as lesbian, gay, or bisexual. These data point to double or triple use rates by LGB respondents, for all substances. <ref>https://clearbrook.banyantreatmentcenter.com/news/lgbtq-substance-abuse-facts-and-tatistics/</ref> When a coalition examines the membership of its community, it should look at not only the specific needs of racial, ethnic, and LGBTQ+ communities, but also evaluate the concerns of military-connected people, individuals with disabilities, and those with lower socio-economic status.

One example might help to humanize what may seem to be abstract demographic characteristics. This points to the complexity of systems which are faced in one specific case. Someone named Chris has just been released from prison and is returning home. Chris is fortunate enough to have been supported in developing a recovery plan which includes medication-assisted treatment/recovery (MAT/MAR). However, Chris’s parole officer maintains that Chris cannot use any substances, MAT/MAR, or otherwise. Instead Chris is required to do x, y, and z, none of which are in the recovery plan. A lack of re-entry services and laws in Chris’s state precluded applying for Medicaid in advance. Chris left jail with three days of medication, but cannot see a doctor for a week. Chris is unable to find recovery housing with nearby transportation who will accept someone with a criminal background, so has not yet found employment. Without a job and without prescription coverage, Chris cannot afford to get more medication. The doctor wants to prescribe medications which the parole officer will not allow. If coalition members understand how their local systems are not working together and are working against people, then they can begin to see how difficult daily life might be for undocumented people or LGBTQ+ youth who are ready but uncertain as to how to access substance use services.

= Relevant Research =

*'''This article''' addresses disparities in treatment and access to treatment, regarding economic status and race/ethnicity. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6087681/</ref>

*'''The Boston University Center for Antiracist Research''' is a collaborative research and education effort which includes Racial Data Lab, a national online database of racial inequality, and a qualitative (narrative) archive. <ref>https://www.bu.edu/antiracism-center/antiracism-research/</ref>

*'''O'Neill Institute for National and Global Health Law''' published "The Context: Racial and other Disparities in the Opioid Crisis." <ref>https://oneill.law.georgetown.edu/wp-content/uploads/2024/03/240308-APP-Policy-Scholar-Lauren-N-WEB.pdf</ref>

= Available Tools and Resources =

*'''SAMHSA.''' This text includes a chapter allocated to behavioral health treatment for major racial and ethnic groups. <ref>https://store.samhsa.gov/sites/default/files/d7/priv/sma14-4849.pdf</ref> SAMHSA also manages the Prevention Technology Transfer Center Network (PTTC) and this presentation covers by the Southwest PTTC covers unique challenges faced by marginalized communities in accessing substance use prevention resources and effective strategies for engaging and empowering all communities. <ref> https://pttcnetwork.org/wp-content/uploads/2024/05/Mobilizing-vulnerable-populations-PPT.pdf</ref>

*'''SAFE Project''' has published “Resources for Diverse Populations” which provides links to a suite of resources for a variety of populations. Typically, it will take a combination of several strategies to reduce disparity. Therefore, it is important that there be as much input as possible when considering what needs to be done in a given community. <ref>https://www.safeproject.us/resource/resources-for-diverse-populations/</ref>

*'''United Nations.''' The UN Partnership on the Rights of Persons with Disabilities and UN Women have published “Intersectionality Resource Guide and Toolkit: An Intersectional Approach to Leave No One Behind." It was developed to help both organizations and individual practitioners address intersectionality in policies and in programs. It aims to contribute to an understanding of intersectionality that bridges the gap between theory and practice. <ref>https://wrd.unwomen.org/practice/resources/intersectionality-resource-guide-and-toolkit</ref>

*'''JUSTICE SQUARED (Just Leaders for a Just Health System)''' is a collective which is supported by the Robert Wood Johnson Foundation. It aims to create practical, impactful, structural change to advance health equity and racial justice. <ref>https://justicesquared.org/</ref>

*'''The Hawai’i Department of Health''' manages the ‘Ohana Center of Excellence, which provides training and technical assistance for those working in substance use, behavioral, and mental health to better serve the needs of the Asian American, Native Hawaiian, and Pacific Islander (AANHPI) communities through culturally responsive care. Their website provides access to a variety of workshops and research articles. <ref>https://aanhpi-ohana.org/</ref>

*'''"How to Be an AntiRacist"''' is a best-selling book by Ibram X. Kendi. Since racism is often what is being left unsaid in addressing disproportionality, this book, while not directly about health inequity, provides a broad understanding of racism and other “-ism’s” and includes recommendations for building a more just society.

*'''The Drug Policy Alliance''' has published three facts sheets on the impact of the overdose crisis on Black, Native American, and Latinx communities. <ref>https://drugpolicy.org/resource/fact-sheet-the-impact-of-the-overdose-crisis-on-black-communities-in-the-united-states/</ref>

= Promising Practices =

*'''Arkansas.''' This project aims to reduce alcohol use among black men by providing screening and brief interventions in a barbershop. <ref>https://health-equity-action.org/project/crhs-3</ref>

= Sources =

Intersectionality and Addressing Disparities

2025-02-20T18:34:30Z

Tracy: /* Key Information */

2025-01-23T19:32:06Z

Tracy:

Treatment services for individuals with a substance use disorder diagnosis include assessment, the development of a treatment plan, implementation of the treatment plan, evaluation, case management, extended care, and monitoring. Programs vary in length and intensity, and they may include approaches like medical stabilization/detox, counseling and behavioral healthcare, and rehabilitation services. In treatment, the ASAM Criteria (American Society Of Addiction Medicine) is the most widely used and comprehensive set of standards for placement, continuation of services, and determining levels of care for individuals seeking treatment for substance use disorder. Level of care recommendations and treatment plans are developed based on multidimensional patient assessments that consider the patient’s medical, psychological, and social needs to help determine what services are a best fit to meet individual and/or patient needs. Additionally, when utilizing ASAM criteria, these guideline assessments take into account an individual's strengths, needs, resources, and recovery capital. Levels of care/continuum of care include:

https://www.yoursafesolutions.us/misc/asam-dimension-changes-800w.jpg

''(Figure 1 ASAM American Society Of Addiction Medicine, 2024) ''

In SAFE Solutions, treatment themes, which are addressed below, are tightly linked to issues addressed across the full spectrum of the Institute of Medicine's (IOM) Continuum of Care, and the reader is strongly encouraged to read each of the other five overview articles. Three clusters of treatment articles are provided.

The first menu, "[[Focus on Effective Treatment]]," addresses general treatment themes. The second menu details considerations on Medicated Assisted Treatment (MAT)/Medicated Assisted Recovery (MAR), and the last menu addresses treatment concerns linked to the criminal justice system.

*"[[Support and Advance Effective Treatment]]" addresses the major types of treatment options and provides an introduction to the framework within which new treatment services are developing.
*"[[Improve Links to Treatment for People who Experience Non-Lethal Overdoses or Naloxone Revivals]]" covers a specific harm reduction strategy which treatment providers should prioritize.
*"[[The Role of Treatment Providers in Promoting Early Intervention, Harm Reduction, And Recovery]]" addresses the unique opportunity that treatment providers have in advancing efforts across the continuum of care.
*"[[Enhance Collaboration Among Medical, Behavioral Health, and Social Services Providers]]" spells out the synergistic benefits of service provision to families through collaborative efforts. It also details the mechanics of a family-centered approach.
*"[[Expand and Enhance Speciality Courts]]" describes the variety of specialty courts which are often referred to as drug courts. It provides the historical context within which the implementation of these courts has increased, and it documents their individual and social benefits.
*"[[Shift from Punishment to Treatment in the Criminal Justice System]]" advocates for the need to address the correlation between recidivism and substance use disorder by amplifying treatment options available to the judicial system.
*"[[Expand Perinatal Treatment and Support for People with SUDs]]" is the first in a cluster of three articles focused on the community role in norm change around pregnancy and substance use. It provides the context for the following two articles.
*"[[Improve Care for Babies Born Drug Dependent]]" covers treatment options for FAS and NAS.

Articles which focus on MAT/MAR include:

*"[[Expand Access to Medicated Assisted Treatment/Recovery (MAT/MAR)]]" provides a detailed coverage of the MAT/MAR process, medication choices involved, and the community context within which MAT/MAR must be promoted.
*"[[Accelerate the Development of New MAT/MAR Approaches]]" covers the need for innovation in the MAT/MAR field and an FDA program designed to foster treatment approaches.
*"[[Expand DNA Testing to Improve Precision MAT/MAR Therapies]]" highlights the benefits of Precision/Personalized Medicine and its emergent status.
*"[[Expand the Use of MAT/MAR in Correctional Facilities]]" bridges to the focus of the next cluster of articles.
*"[[Expand Access to MAT/MAR for Pregnant People]]" supplements a cluster of MAT/MAR articles within SAFE Solution's menu on Treatment. It provides information specifically relevant for the role of MAT/MAR during and after pregnancy.

More than half of those in U.S. prisons and jails meet the criteria for substance use disorders, so correctional institutions are looking for best practices which they can use to help handle the increased demand for substance use treatment, including diversion and drug courts, treatment while incarcerated, and reentry services. Articles which focus on criminal justice involvement include:
*"[[Expand Law Enforcement Assisted Diversion and Deflection Programs]]" defines the difference between diversion and deflection approaches and provides examples of the benefits of both types of programs.
*"[[Expand First Response and Crisis Intervention Teams]]" supplements the previous article, which has a focus on law enforcement, with a focus on the role of other first responders, such as EMS, fire departments, and behavioral health outreach workers.