Evaluating equity in community-based naloxone access among racial/ethnic groups in Massachusetts

Background: Racial/ethnic minorities have experienced disproportionate opioid-related overdose death rates in recent years. In this context, we examined inequities in community-based naloxone access across racial/ethnic groups in Massachusetts.Methods: We used data from: the Massachusetts Department of Public Health on community-based overdose education and naloxone distribution (OEND) programs; the Massachusetts Office of the Chief Medical Examiner on opioid-related overdose deaths, and; the United States Census American Community Survey for regional demographic/socioeconomic details to estimate community populations by race/ethnicity and racial segregation between African American/Black and white residents. Race/ethnicity groups included in the analysis were Af-rican American/Black (non-Hispanic), Hispanic, white (non-Hispanic), and other (non-Hispanic). We evaluated racial/ethnic differences in naloxone distribution across regions in Massachusetts and neighborhoods in Boston descriptively and spatially, plotting the race/ethnicity-specific number of kits per opioid-related overdose death per jurisdiction. Lastly, we constructed generalized estimating equations models with a negative binomial dis-tribution to compare the race/ethnicity-specific naloxone distribution rate by OEND programs.Results: From 2016-2019, the median annual rate of naloxone kits received from OEND programs in Massa-chusetts per racial/ethnicity group ranged between 160 and 447 per 100,000. In a multivariable analysis, we found that the naloxone distribution rates for racial/ethnic minorities were lower than the rate for white resi-dents. We also found naloxone was more likely to be distributed in racially segregated communities than non-segregated communities.Conclusion: We identified racial/ethnic inequities in naloxone receipt by individuals in Massachusetts. Additional resources focused on designing and implementing OEND programs for racial/ethnic minorities are warranted to ensure equitable access to naloxone.

Automated summary

This study reveals racial/ethnic inequities in the access to naloxone in Massachusetts, with minority groups having lower distribution rates compared to white residents. Moreover, naloxone distribution is more likely to occur in racially segregated communities.