Response to Reed and Socias letter

KEYWORDS:

• Opioid use disorder
• women
• treatment
• health inequities

We greatly appreciate Drs. Reed and Socias’ insightful comments on our recently published article highlighting the racial and ethnic inequities in substance use treatment among women with OUD (1). As researchers who embrace harm reduction approaches to substance use, we firmly agree that harm reduction must be tailored to the specific needs of Black, Indigenous, and Other People of Color (BIPOC) individuals who use drugs who have been especially harmed and targeted by the punitive approaches to address substance use employed in the United States. While our study focused specifically on substance use treatment inequities, in recent work with other colleagues regarding inequities in the naloxone care cascade, we found that Black and Hispanic women who used illicit opioids had lower rates of naloxone training, possession, and use relative to White women and men (2). We have observed similar intersecting gender, racial, and ethnic inequities in the use of syringe services programs (SSPs) (3).

In addition to providing harm reduction services, SSPs are a critical avenue for expanding MOUD to vulnerable populations (4,5), including those who are unhoused or disconnected from the traditional healthcare system. Drs. Reed and Socias highlight the need to optimize SSPs for BIPOC people who use drugs to feel comfortable using SSPs. For example, fear of arrest prevents SSP engagement (6) – even when the SSP is operating legally – and that fear may be heightened among this population (7). Indeed, a national survey of SSP managers found that those primarily serving BIPOC people who injected drugs were 3.56 times more likely to report participant arrest en route to the SSP than those primarily serving White people (8). Fears of criminal-legal involvement may be further heightened among women of color, due to the potential removal of children by the child welfare system (9,10). Significantly more research is needed to understand how SSPs could be tailored to meet the intersecting needs of women and BIPOC individuals who use drugs.

We believe a crucial component to effectively carry out this research is that researchers must authentically partner with the true experts in this area: people with lived and living experiences of substance use. Harm reduction arose from grassroots organizations and thrived well before public health and medical professionals became involved (11). The Urban Survivors Union, a national union of people who use drugs in the United States, have provided researchers with their invaluable insight on experiences in their dual roles as activists and researchers. They have put forth recommendations for community-driven research that ensures people who use drugs are meaningfully involved in driving the entire research process from formulating the research agenda through interpretation and dissemination of findings (12). Research groups embracing community-driven research frameworks are advancing substance use treatment and harm reduction and reducing health inequities among people who use drugs (13–15). To accomplish our goal of creating treatment and harm reduction services that are inclusive for all gender, racial, and ethnic groups of people who use drugs, we must ensure that those very communities are our guides in determining how to do so.

Disclosure statement

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

Additional information

Funding

This work was supported by the NYU Langone Center for Opioid Epidemiology and Policy Tarlise Townsend Memorial Grant Program.