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Issues: To date, there has been no synthesis of research addressing the scale and nuances of the opioid epidemic in racial/ethnic minority populations in the United States that considers the independent and joint impacts of dynamics such as structural disadvantage, provider bias, health literacy, cultural norms and various other risk factors. Approach: Using the "risk environment" framework, we conducted a scoping review on PubMed, Embase and Google Scholar of peer‐reviewed literature and governmental reports published between January 2000 and February 2024 on the nature and scale of opioid use, opioid prescribing patterns, and fatal overdoses among racial/ethnic minorities in the United States, while also examining macro, meso and individual‐level risk factors. Key Findings: Results from this review illuminate a growing, but fragmented, literature lacking standardisation in racial/ethnic classification and case reporting, specifically in regards to Indigenous and Asian subpopulations. This literature broadly illustrates racial/ethnic minorities' increasing nonmedical use of opioids, heightened burdens of fatal overdoses, specifically in relation to polydrug use and synthetic opioids, with notable elevations among Black/Latino subgroups, in addition uneven opioid prescribing patterns. Moreover, the literature implicates a variety of unique risk environments corresponding to dynamics such as residential segregation, provider bias, overpolicing, acculturative stress, patient distrust, and limited access to mental health care services and drug treatment resources, including medications for opioid use disorder. Implications: There has been a lack of rigorous, targeted study on racial/ethnic minorities who use opioids, but evidence highlights burgeoning increases in usage, especially polydrug/synthetic opioid use, and disparities in prescriptions and fatal overdose risk‐phenomena tied to multi‐level forms of entrenched disenfranchisement. Conclusion: There is a need for further research on the complex, overlapping risk environments of racial/ethnic minorities who use opioids, including deeper inclusion of Indigenous and Asian individuals, and efforts to generate greater methodological synergies in population classification and reporting guidelines. [ABSTRACT FROM AUTHOR]

Background and Objectives: While inadequate nutrition can weaken the immune system and lead to negative health sequelae for vulnerable populations, little is known about nutritional intake among people who inject drugs (PWID). We aimed to quantify nutritional intake among PWID and to explore associations between protein intake and drug use. Methods: A cross‐sectional design was used to analyze self‐reported participant data. PWID were recruited from community settings in California in 2016/2017. Participants reported on food consumption per day for a 30‐day period, from which a continuous protein intake variable was created. Results: Modal characteristics of participants (N = 937) were: white (42.5%), male (75.3%), healthy body mass index (BMI) (56.6%), and unhoused (82.9%). Less than 1% of participants met or exceeded recommended guidelines for protein intake (0.80 g/day/1 kg body weight). The final multiple regression model found protein intake to be significantly positively associated with older age, high school or greater education, frequency of opiate and marijuana use, while Latinx ethnicity was inversely associated with protein intake, adjusting for gender. Discussion and Conclusions: Our study shows PWID are generally not underweight, yet they are grossly protein deficient, which can be harder to recognize. Poverty, homelessness, and other structural barriers likely contribute to this issue, which demonstrates the need for communities to provide more access to nutrient‐rich food to PWID. Scientific Significance: Our study demonstrates the novel findings that opiate and marijuana use frequency, but not stimulants (methamphetamine and cocaine) may increase preference for protein‐rich foods among PWID. [ABSTRACT FROM AUTHOR]

Purpose: This study explored potentially underreported healthcare contexts, clinical experiences, and motivations for adherence in care among virally suppressed Black sexual minority men (BSMM) living with HIV (LWHIV) in Baltimore, MD. Methods: Go‐alongs with two virally suppressed BSMM LWHIV supplemented 27 in‐depth interviews of a larger qualitative study guided by Positive Deviance and Life Course Theory. The go‐alongs involved accompanying participants' follow‐up HIV care visit to obtain a better account of contextual healthcare factors. Observations focused on (1) clinic location and resources, (2) sources of HIV and sexuality stigma or support in the clinic, and (3) patient‐provider interactions. Results: We found that facilitators and barriers to viral suppression for BSMM LWHIV included structural factors (i.e., healthcare setting, facility, and services), quality of patient‐provider interactions, and personal motivations to achieve viral suppression. Conclusion: Clinic accessibility, co‐located clinical services, and rapport with clinicians and healthcare staff could be key contextual conditions that facilitate retention in care among BSMM LWHIV. [ABSTRACT FROM AUTHOR]

Objective: To examine factors associated with adverse consequences of alcohol consumption among a community sample of drinkers in a low-income, racial, and ethnic minority community. Methods: A sample of 329 drinkers was recruited from 17 randomly selected off-sell alcohol outlets in South Los Angeles. Respondents were interviewed by trained research personnel on their demographic characteristics, income, drinking patterns and preferences, and alcohol-related adverse consequences (using the Drinkers Inventory of Consequences—DrInC), among other items. We developed logistic regression models predicting high scores on DrInC total score and subscales (impulse control, interpersonal, intrapersonal, physical, and social responsibility). Results: In this sample, we found drinking patterns—bingeing, drinking outdoors, drinking in the morning—to be significantly associated with total DrInC scores and some subscales. Malt liquor beverage (MLB) use was significantly associated with total DrInC score and interpersonal and social responsibility subscales. Previous alcohol treatment predicted all but 1 DrInC subscale and total score. Conclusions: A diverse array of factors predicted high DrInC total and subscale scores. More research on the association between MLB use and consequences is required. In addition, studies with community samples are likely to further enrich our understanding of the interactions between drinking patterns and preferences, settings, and negative consequences. [ABSTRACT FROM AUTHOR]

Objective: To determine whether racial and ethnic disparities in publicly funded alcohol treatment completion are due to racial differences in attending outpatient and residential treatment. Methods: Statistical analysis of alcohol treatment completion rates using alcohol treatment patients’ discharge records from all publicly funded treatment facilities in Los Angeles County from 1998 to 2000 ( n = 10,591). Results: Among these patients, African American (OR = 0.52; 95% CI 0.47, 0.57) and Hispanic (OR = 0.89; 95% CI 0.81, 0.99) patients were significantly less likely to complete treatment as compared with White patients. We found that the odds of being in outpatient versus residential care were 1.42 (95% CI 1.29, 1.55) and 2.05 (95% CI 1.85, 2.26) for African American and Hispanic alcohol treatment patients, respectively, compared with White patients. Adjusting for addiction characteristics, employment, other patient-level factors that might influence treatment enrollment, and unobserved facility-level differences through a random effects regression model, these odds increased to 1.89 (95% CI 1.22, 2.94) for African American and to 2.12 (95% CI 1.40, 3.21) for Hispanics. We developed a conditional probability model to assess the contribution of racial differences in treatment modality to racial disparities in treatment completion. Estimates from this model indicate that were African American and Hispanic patients observed in outpatient care in this population to have the same probability of receiving residential care as White patients with otherwise similar characteristics, the White–African American difference in completion rates would be reduced from 13.64% (95% CI 11.58%, 15.71%) to 11.09% (95% CI 8.77%, 13.23%) and the White–Hispanic difference would disappear, changing from 2.63% (95% CI 0.29%, 4.95%) to −0.45% (−3.52%, 2.43%). Conclusion: It appears that reductions in racial disparities in treatment completion could be gained by increasing enrollment in residential alcohol treatment for African American and Hispanic alcohol abusers in Los Angeles County. Further research addressing why minority alcohol abusers are less likely to receive residential alcohol treatment should be conducted, as well as research that examines why African American alcohol treatment patients have lower completion rates as compared with White patients regardless of treatment modality. [ABSTRACT FROM AUTHOR]

Aim To determine whether syringe exchange programs' (SEPs) dispensation policy is associated with syringe coverage among SEP clients. Design Cross-sectional samples of SEPs and their clients. Setting SEPs in California, USA. Participants Twenty-four SEPs and their injection drug using (IDU) clients ( n = 1576). Measurements Clients were classified as having adequate syringe coverage if they received at least as many syringes from the SEP as their self-reported injections in the last 30 days. SEPs were classified based on their syringe dispensation policy. Dispensation schemes ranging from least restrictive to most are: unlimited needs-based distribution; unlimited one-for-one exchange plus a few additional syringes; per visit limited one-for-one plus a few additional syringes; unlimited one-for-one exchange; and per visit limited one-for-one exchange. Findings Adequate syringe coverage among SEP clients by dispensation policy is as follows: unlimited needs-based distribution = 61%; unlimited one-for-one plus = 50%; limited one-for-one plus = 41%; unlimited one-for-one = 42%; and limited one-for-one = 26%. In multivariate analysis, adequate syringe coverage was significantly higher for all dispensation policies compared to per visit limited one-for-one exchange. Using propensity scoring methods, we compared syringe coverage by dispensation policies while controlling for client-level differences. Providing additional syringes above one-for-one exchange (50% versus 38%, P = 0.009) and unlimited exchange (42% versus 27%, P = 0.05) generally resulted in more clients having adequate syringe coverage compared to one-for-one exchange and per visit limits. Conclusion Providing less restrictive syringe dispensation is associated with increased prevalence of adequate syringe coverage among clients. SEPs should adopt syringe dispensation policies that provide IDUs sufficient syringes to attain adequate syringe coverage. [ABSTRACT FROM AUTHOR]

Objectives. To assess racial and ethnic differences in rates of completion from publicly funded alcohol treatment programs, and to estimate the extent to which any identified racial differences in completion rates are related to differences in patient characteristics. Data Sources. Administrative intake and discharge records from all publicly funded outpatient and residential alcohol treatment recovery programs in Los Angeles County (LAC) during 1998–2000. Study participants ( N=10,591) are African American, Hispanic, and white patients discharged from these programs, ages 18 or older, who reported alcohol as their primary substance abuse problem. Study Design. Bivariate tests identified racial and ethnic differences in rates of treatment completion and patient characteristics. Logistic regression models assessed the contribution of differences in patient characteristics to differences in completion. Principal Findings. Significantly lower completion rates by African Americans (17.5 percent) relative to whites (26.7 percent) (odds ratio [OR]=0.58, 95 percent confidence interval [CI]: 0.50–0.68) are partially explained (40 percent) by differences in patient characteristics in outpatient care (adjusted OR=0.75, 95 percent CI: 0.63–0.90), mostly by indicators of economic resources (i.e., employment, homelessness, and Medi-Cal beneficiary). In residential care, only 7 percent of differences in completion (30.7 versus 46.1 percent) could be explained by the patient-level measures available (OR=0.52, 95 percent CI: 0.45–0.59; AOR=0.55, 95 percent CI: 0.47–0.65). Differences in completion rates between Hispanic and white patients were not detected. Conclusions. Large differences in rates of outpatient and residential alcohol treatment completion between African American and white patients at publicly funded programs in LAC, the nation's second largest, publicly funded alcohol and drug treatment system, are partially because of economic differences among patients, but remain largely unexplained. These racial disparities merit additional investigation and the attention of health professionals. [ABSTRACT FROM AUTHOR]

Better sterile syringe access should be associated with a lower likelihood of syringe re-use and receptive syringe sharing, although few empirical studies have examined gradients in syringe access using both individual and ecological data. In this study, we compare syringe re-use and receptive syringe sharing among injection drug users (IDUs) with syringe exchange program (SEP) and legal over-the-counter pharmacy access with limits on syringes that can be purchased, exchanged or possessed to IDUs with no pharmacy sales but unlimited syringe access through SEPs. We address three questions: ( ) Does residing in an area with no legal syringe possession increase the likelihood of police contact related to possessing drug paraphernalia? ( ) Among direct SEP users, is use of more permissive SEPs associated with less likelihood of syringe re-use and receptive syringe sharing? ( ) Among non-SEP users, is residing in an area with pharmacy access associated with lower likelihood of syringe re-use and receptive syringe sharing? Quantitative survey of IDUs recruited from SEPs, subject nomination and outreach methods. Multivariate analyses compared police contact, syringe re-use and receptive syringe sharing among IDUs recruited in three cities. In multivariate analyses, we found that police contact was associated independently with residing in the area with no legal possession of syringes; among SEP users, those with access to SEPs without limits had lower syringe re-use but not lower syringe sharing; and that among non-SEP users, no significant differences in injection risk were observed among IDUs with and without pharmacy access to syringes. We found that greater legal access to syringes, if accompanied by limits on the number of syringes that can be exchanged, purchased and possessed, may not have the intended impacts on injection-related infectious disease risk among IDUs. [ABSTRACT FROM AUTHOR]

Aims Injection drug use is a major risk factor for HIV and hepatitis infections. Whereas programs to prevent new infections have focused on HIV, they have generally neglected hepatitis B and C. This study was designed to examine the interrelationships among HIV and hepatitis knowledge, risky drug preparation and injection practices, and participation in syringe exchange programs (SEPs). Design Surveys of injection drug users (IDUs) collected data on sociodemographics, medical history, drug use and injection practices, and HIV- and hepatitis-related knowledge. Setting Inner-city US neighborhoods in Chicago, 1L, Hartford, CT and Oakland, CA. Participants The study population was a convenience sample of 493 IDUs recruited using street outreach and snowball sampling strategies. Measurements HIV and hepatitis knowledge, injection-related risks for virus transmission, associations between the two, and with SEP use. Findings HIV knowledge was significantly higher than hepatitis knowledge among SEP customers and non-customers alike. Elevated hepatitis knowledge was associated with a history of substance abuse treatment, hepatitis infection, hepatitis B vaccination and injection practices that reduced contact with contaminated blood or water but not with SEP use. SEP customers were consistently less likely to engage in risk behaviors, with the notable exception of safely staunching blood postinjection. Conclusion Increased hepatitis awareness among IDUs is necessary for reducing hepatitis transmissions. Although SEPs continue to effectively disseminate HIV prevention messages—as evidenced by lowered risk behaviors among their customers—they must do more to prevent hepatitis transmissions. [ABSTRACT FROM AUTHOR]

Aims. To assess risk factors associated with injection drug users (IDUs) who give injections to or receive injections from other IDUs. Design and setting. IDUs were recruited into a cross-sectional study using targeted sampling methods in Oakland, Richmond, and San Francisco, California from August 1996 to January 1997. "Street docs" are IDUs who reported having given injections to other IDUs in the past month. "Injection recipients" are IDUs who reported having received injections from other people in the past month. Participants. Of 1166 IDUs interviewed, 283 (24%) reported being injection recipients and 427 (37%) reported being street docs. Measurements. Socio-demographic characteristics and injection-related risk behaviors. Findings. Injection recipients and street docs were significantly more likely (p<0.001) than other IDUs to report sharing syringes (33% of injection recipients, 21% of street docs and 7% of others), cookers (71% of injection recipients, 55% of street docs and 24% of others), rinse water (44% of injection recipients, 35% of street docs and 13% of others), and filters (60% of injection recipients, 47% of street docs and 20% of others). In a logistic regression model, injection recipients (adjusted odds ratio (AOR) = 4.29) and street docs (AOR = 1.91) were more likely than other IDUs to report having shared syringes. Conclusions. Giving and receiving injections is common among IDUs in the San Francisco Bay area. Qualitative and epidemiological studies are needed to understand better the infectious disease risks associated with giving and receiving injections. Interventions need to address these issues and provide practical solutions. [ABSTRACT FROM AUTHOR]

The authors reflect on intravenous drug use research and action in injection initiation. They mention a systematic review and meta-analysis by L. Sordo and others that examined potential bias caused by outcome-related loss to follow-up for injection drug abuse and comment on three issues that also need to be researched. They talk about the need to create and implement prevention strategies which address susceptible people and drug users, and broaden the view of at-risk populations.

In this article the authors comments on the search for comprehensive approaches to the risk of HIV among drug users. They note a study indicating the significant role of sexual risk as a component of HIV epidemic among drug users. They mention the trend on the increased availability and use of stimulant drugs that may increase sex-associated HIV risk, the proliferation of injection drug use, and the necessity for more and better HIV prevention strategies and intervention.

Background: The authors describe and compare drinking patterns among malt liquor beer (MLB), regular beer (RB), and hard liquor (HL) drinkers in a low-income, racial/ethnic minority community., Methods: Drinkers were recruited from randomly selected alcohol outlets in South Los Angeles. Respondents were assessed on sociodemographic characteristics, alcohol use history, drinking patterns, and drinking context among other items in a face-to-face interview with research staff., Results: Three hundred twenty-nine drinkers were interviewed, of whom 297 reported drinking MLB, RB, or HL brands of alcohol most often in the past 90 days. This subsample was 88% African-American, 72% male, and 35% unemployed. As compared with RB and HL drinkers, MLB drinkers were more likely to be homeless, to receive public assistance for housing, and to be unemployed. MLB drinkers also reported significantly higher rates of daily or near-daily drinking (74%, as compared with 48% for RB and 29% for HL) of drinks per day on drinking days (5.2, as compared with 4.2 for RB and 3.1 for HL), and daily average ethanol consumption (6.97 oz, as compared with 2.13 oz for RB drinkers and 6.13 oz for HL drinkers). In multinomial regression analysis that controlled for potential confounders, the odds of preferring RB as compared with MLB were significantly increased among persons with blue-collar occupations and those who reported drinking in public settings and were reduced among persons who drank outdoors, those who combined drinking with tobacco smoking, and those who drank alcohol with members of the same sex. Average daily ethanol consumption odds were reduced for RB drinkers as compared with MLB drinkers. The odds of preferring HL as compared with MLB were significantly increased for persons with white-collar occupations and those who drank in public settings and were reduced for persons who drank outdoors and those who combined drinking and smoking., Conclusion: The authors observed substantial differences in sociodemographic characteristics, drinking patterns, and ethanol consumption by beverage type in this community sample. MLB drinkers seem to have distinctive drinking patterns that require additional study to determine whether this pattern is associated with increased individual or community risk.