Reducing harms and deaths from overdose
An equity-oriented approach to address systemic injustices
Authors of two JBI scoping reviews provide their perspectives on an equity-oriented approach to address systemic injustices to reduce harms and deaths from overdose through their reviews:
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Although the scoping reviews focus on different topics, they complement each other by mapping equity-oriented approaches that address systemic injustices at the root of poor health and lack of access to healthcare, and focus on what is needed for transforming systems. ?
Dr Lenora Marcellus, lead author of the scoping review review on infants with prenatal substance exposure in foster care explains:
The topic areas might feel disparate from the outside looking in. However, the roots of children needing care are grounded in multiple issues of equity, for example poverty and racism. Currently, the opioid epidemic is having a substantial impact on the number of children coming into care. The fact that people with substance use disorders are often parents can get missed in media coverage and academic discourse. Solutions that address underlying equity challenges will strengthen family circumstances and hopefully support families staying together and thriving.
Both reviews point to the need to end the stigma associated with drug overdoses. Dr Bernadette Pauly is the lead author of the scoping review that maps health equity-oriented responses to overdose, stigma and discrimination. She has seen first hand the harm associated with stigma:?
Members of our?team have been working for many years with community organizations and groups impacted by escalating rates of drug overdose deaths. We have seen the disproportionate impact of overdose and stigma on our community partners including people with lived and living experience. Overdose deaths due to a toxic drug supply are a tragic and preventable public health crisis that is driven by systemic inequities associated with colonization, criminalization, poverty and homelessness. Stigma has been identified as a barrier to implementation of interventions to address overdoses.?
Read together, the reviews examine health and social care interventions that follow the life span from prenatal substance exposure and infancy to the potential harm or death from overdose. Dr Marcellus explains: ?
"The "infants in care" review represents one downstream path for the "equity" review as parental substance use is a growing cause for why children are removed from families and placed in care. The issue of stigma is highly applicable to families who are required to interact with child welfare and child protection services."
While conducting the scoping review, Dr Marcellus found that few evidence-informed interventions were available to support this vulnerable population:?
"Because I have been studying this area for a long time, it was interesting to see how much the science of brain development and the concepts of infant mental health and adverse childhood experiences were now influencing practice and research. I was surprised to note that there were still few evidence-informed interventions and programs available for communities to implement."
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Dr Marcellus was also surprised that, despite the awareness that children from Indigenous and other racialized communities are overrepresented in care, there is less critical analysis noted overall in the included literature.?
The authors of the scoping review on equity-oriented frameworks to inform responses to opioid overdoses also found gaps in the literature. While most of the literature that was mapped incorporated the concept of harm reduction into a health equity-oriented approach, the concepts of cultural safety, and trauma- and violence-informed care were lacking: ?
"While it is promising to find harm reduction feature so prominently, it is important to consider how harm reduction can be integrated with cultural safety as well as the importance of addressing barriers that are rooted in colonization and other forms of structural violence through trauma- and violence-informed care", says Dr Pauly.?
The need for trauma- and violence-informed care underscores the importance of involving people with lived and living experience when developing recommendations for equity-oriented responses to overdose and stigma: "This expertise should be recognized and valued in policy, programs and practice", Dr Pauly stresses.
"System-level responses should include multifaceted responses to address stigma and discrimination including attention to drug policy reform.?Both universal and targeted responses are needed to reduce population-level harms of overdose and stigma." ??
However, implementing these solutions is difficult, despite them being the ‘right thing’ to do and cost-effective:?
"The solutions identified in these reviews are the right things to do, not just because of human rights and ethical perspectives, but also because they are cost effective in the long-run. The issue of addiction is intergenerational and has a substantial impact on community well-being. Unfortunately, this issue is heavily politicized, which creates barriers to implementing practices that we know are effective", says Dr Marcellus.
31 August is International Overdose Awareness Day. These scoping reviews were published in a special issue of JBI Evidence Synthesis to mark this day. Editorial in this issue, International Overdose Awareness Day: a time to remember, a time to act, a time for evidence provides an overview of the two systematic reviews.
The editorial is summarised in an Editorial in Motion: