Socioeconomic marginalization and opioid-related overdose: A systematic review

• Published in: Drug and alcohol dependence Vol. 214; p. 108127
• Main Authors: van Draanen, Jenna, Tsang, Christie, Mitra, Sanjana, Karamouzian, Mohammad, Richardson, Lindsey
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.09.2020; Elsevier Science Ltd
• Subjects: Analgesics, Opioid; Citations; Crime; Criminal justice; Criminal justice system; Data collection; Decision making; Drug overdose; Drug Overdose - economics; Drug Overdose - psychology; Drug-related death; Economic conditions; Educational Status; Educational systems; Employment; Fairness; Health disparities; Health education; Health initiatives; Health insurance; Homeless people; Homelessness; Housing; Humans; Income; Judicial system; Lumping; Marginality; Narcotics; Opiate Overdose; Opioids; Overdose; Poisoning; Poverty; Public health; Public policy; Social exclusion; Social factors; Social interactions; Social Problems; Social support; Socioeconomic data; Socioeconomic Factors; Socioeconomic status; Socioeconomics; Synthesis; Systematic review; Teams; Toxicity; Poisoning; Poverty; Socioeconomic status; Toxicity; Drug-related death
• ISSN: 0376-8716; 1879-0046; 1879-0046
• DOI: 10.1016/j.drugalcdep.2020.108127

•34/37 studies showed at least one measure of SEM associated with overdose.•Evidence for associations of health insurance, income, education, incarceration, social support, and SES with overdose.•Marginalization is associated with added precarity and risk for people who use opioids.•Initiatives aiming to decrease SEM are a necessary part of combatting overdose. 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. 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. 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. 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.