An Integrated Geospatial and Community-based Model to Prevent Opioid Overdose among Black Americans

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PROJECT SUMMARY Opioid overdose death (OOD) rates in the among Black individuals in the U.S. have increased unabated since 2015, outpacing those of White individuals at a rate of two to one. Racial disparities in the growth rate of OOD have been documented in at least 23 states, including Missouri, which has second highest rate of OOD among Black individuals: 44 per 100,000 (relative to 16 per 100,000 nationally). There is a critical need to identify and mitigate social determinants of health (SDOH) that drive increasing racial inequities in OOD and opioid use disorder treatment utilization. One strategy that addresses SDOH—such as low geographic access to treatment and high neighborhood deprivation—is community-based outreach, which dispatches peers and community health workers to provide harm reduction tools and linkages to evidence-based treatment. Although outreach efforts improve psychoeducation and access to treatment for Black people who use opioids, existing efforts are limited by a lack of data-driven targets. Thus, there is an urgent need to identify and disseminate geographic and structural drivers of OOD among Black individuals to improve the efficacy of existing outreach interventions and in turn, improve treatment access. The current K08 proposal addresses this need by integrating geospatial information systems (GIS) technology and community based participatory research to create a digital tool designed to 1) identify current SDOH that underlie OOD among Black individuals and 2) provide data-driven targets to improve the efficacy of community-based outreach interventions. The project aims and career development plan will concurrently support Dr. Banks’ transition to an independent clinical investigator focused on the integration of technology and community engagement to improve substance use treatment among minoritized racial/ethnic groups. Specific aims of the project are to 1) develop and evaluate the predictive validity of a GIS-enabled index (the “Overdose Racial Equity Index”) to model risk for OOD among Black individuals based on SDOH identified and rated by community experts and 2) demonstrate initial acceptability and utility of the Overdose Racial Equity Index to guide outreach interventions for Black OOD via focus groups with peers and community health workers. Aims and related training opportunities facilitated by the rich intellectual environment of the University of Missouri—St. Louis and the two other research institutions in St. Louis will support Dr. Banks’ training goals to gain expertise in digital/mobile health therapeutics, opioid use disorder treatment, and implementation science. Outcomes include the identification of SDOH that underlie OOD among Black Americans and a research and replicable implementation model for other regions to identify policy and intervention targets that reduce the disproportionate burden of OOD among Black Americans. The research will provide the training and data necessary for an R01 application that tests the effectiveness of a mobile version of the Overdose Racial Equity Index to improve community-based prevention outcomes.