Pathways connecting socioeconomic marginalization and overdose: A qualitative narrative synthesis

Area of Science:

• Public Health
• Sociology
• Addiction Studies

Background:

• Socioeconomic marginalization (SEM) is a critical determinant of health outcomes.
• Understanding the pathways linking SEM to overdose is essential for harm reduction strategies.

Purpose of the Study:

• To identify and synthesize qualitative evidence on the pathways connecting socioeconomic marginalization (SEM) and overdose among people who use drugs.

Main Methods:

• Systematic search of multiple databases (MEDLINE, Embase, PsycINFO, CINAHL, Google Scholar, CENTRAL, CDAG) for qualitative studies (2000-2021).
• Risk of bias and quality assessment using CASP checklist and GRADE-CERQual.
• Thematic synthesis of data from 27 included qualitative articles.

Main Results:

• Four key aspects of SEM influencing overdose risk were identified: resource insufficiency/labor exclusion, homelessness/housing instability, policing/criminalization, and gendered/racialized inequalities.
• A typology of material, behavioral, psychological, social, and environmental pathways connecting SEM to overdose was developed.
• Reciprocal and interconnected relationships between overdose and SEM were observed, with reinforcing mechanisms.

Conclusions:

• Socioeconomic marginalization is strongly linked to drug poisoning through identifiable pathways.
• The interconnectedness of these pathways intensifies overdose risk and perpetuates socioeconomic marginalization.