Harm reduction as treatment for Black and Hispanic individuals: response to Scheidell et al

A recent analysis of past-year substance use treatment among women with opioid use disorder (OUD), published in this journal by Scheidell et al., found that only one-third of women with OUD had received any treatment, and Black and Hispanic women had received treatment at even lower rates (1). This statistic underscores the need for treatment tailored to women of color. As Latina physicians who are substance use clinicians and researchers, we believe that in addition to the recommendations outlined by Scheidell et al., there is also a need to strengthen harm reduction services that are tailored to Black and Hispanic individuals. Further research into specific harm reduction behaviors is one approach to informing the development of such services.

Scheidell et al. make several recommendations to address the racial and ethnic inequity in treatment for OUD, including an expansion of our understanding of treatment to not only include but elevate the importance of harm reduction. We agree with a deliberate focus on strengthening harm reduction as treatment for minoritized racial and ethnic groups. This is an especially crucial area to address because, for many Black and Hispanic people who use drugs, harm reduction infrastructure as it currently exists often fails to address the manifestations of structural racism – things such as fear of police interaction and a history of trauma at the hands of the medical and legal systems – thus limiting the extent to which harm reduction can be effective in these communities (2).

There is a need for both quantitative and qualitative research that explores the aspects of harm reduction that would be most acceptable to women of color, including those at highest risk. Along these lines, our team based in Boston and San Francisco has been evaluating opioid overdose risk and protective behaviors among Black and Hispanic/Latinx individuals with a history of prior overdose. Elucidating how these behaviors (i.e., co-use of opioids with alcohol and benzodiazepines, use of tester doses or slow shots, and use with others) differ by race and ethnicity will help further our understanding of what harm reduction interventions might be most helpful for different sub-populations. This is one step in creating OUD treatment that is not only accessible to people of color, but also tailored toward the unique needs of Black and Hispanic individuals, and will be key to reduce racial and ethnic inequities in our response to overdose.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

GR receives funding from the International Collaborative Addiction Medicine Research Fellowship [NIDA R25-DA037756] and the Research in Addiction Medicine Scholars Program [NIDA R25-DA033211]. MES is supported by a Scholar Award from the Michael Smith Foundation for Health Research/St. Paul’s Hospital Foundation.