Equity-oriented frameworks to inform responses to opioid overdoses: a scoping review

Area of Science:

• Public Health
• Health Equity
• Substance Use

Background:

• Stigma and overdose among people who use illicit drugs or misuse prescription opioids are significant public health concerns.
• Existing approaches often lack a comprehensive health equity focus, necessitating a systematic review of relevant literature.

Purpose of the Study:

• To systematically identify and describe literature utilizing a health equity-oriented approach for preventing and reducing harms associated with stigma or overdose.
• To explore the integration of concepts like cultural safety, trauma- and violence-informed care, and harm reduction within these approaches.

Main Methods:

• A scoping review was conducted following JBI methodology, including published and unpublished literature from January 1, 2000, to July 31, 2019.
• Extensive database searches and targeted searches for unpublished studies were performed.
• Data extraction focused on population, concepts, context, and key findings, with screening and extraction done by two reviewers.

Main Results:

• Of 1065 articles screened, 148 were included, with most published recently (73%) and from North America (78%).
• Harm reduction was the most common approach (n=79), but only 16 articles integrated all three concepts (cultural safety, trauma- and violence-informed care, harm reduction).
• Fourteen articles incorporated an Indigenous-informed perspective. Qualitative studies comprised 44% (n=65), and 26 papers included a framework, though none integrated all three concepts with an Indigenous perspective.

Conclusions:

• Few conceptual frameworks effectively combine health equity orientation with multiple concepts to address the opioid poisoning emergency.
• Further research is needed to evaluate the impact and effectiveness of integrated, health equity-oriented frameworks for practical implementation.