# A Comparison of Opioid Overdose Risk Behaviors by Race and Ethnicity Among Overdose Survivors in Boston, MA, and San Francisco, CA

## TL;DR

This study compares opioid overdose risk behaviors among Black, Latine, and White individuals in Boston and San Francisco, finding that structural factors influence these behaviors more than race alone.

## Contribution

The study identifies structural determinants as key factors in opioid overdose risk behaviors, moving beyond race-focused interventions.

## Key findings

- Overdose risk behaviors were common across all racial and ethnic groups.
- Adjusting for structural factors eliminated significant differences in risk behaviors between Black and White participants.
- Structural determinants of health are critical to address in overdose prevention strategies.

## Abstract

Black and Latine people are at high risk for opioid overdose mortality. Interventions focused on overdose risk behaviors may offer opportunities to reduce the risk of overdose, but little research has addressed racial and ethnic differences in risk behaviors. We explored differences in risk behaviors among Black, Latine, and White individuals who used opioids and had a history of prior overdose.

We used data from REBOOT 2.0 (the REpeated dose Behavioral intervention to reduce Opioid Overdose Trial) based in Boston, MA, and San Francisco, CA, which enrolled people with opioid use disorder and a history of opioid overdose. We used the Andersen behavioral model to inform covariate selection for a multivariable logistic regression analysis examining associations between race/ethnicity (Black, Latine, and White) and three opioid overdose risk behaviors (using opioids alone, not using a tester dose, and using alcohol or benzodiazepines on the same day as opioids).

Of 247 participants, 19% were Black, 16% were Latine and 66% were White. More than 20% in each group reported each risk behavior. In unadjusted analyses, Black participants had higher odds of using alone (OR=2.17, 95% CI 1.08–4.36) but lower odds of not using a tester dose (OR=0.48, 95% CI 0.24–0.93) compared to White participants. After adjusting for age, gender and structural determinants of health (e.g., housing, incarceration, education, opioid use disorder treatment) the adjusted odds of Black participants using alone (aOR=2.05, 95% CI 0.99–4.26) and using a tester dose (aOR=0.56, 95% CI 0.28–1.13) were no longer statistically significant.

Overdose risk behaviors were common among Black, Latine, and White overdose survivors in San Francisco and Boston. Overdose risk behaviors were not significantly different for Black or Latine compared to White overdose survivors after adjusting for age, gender, and structural determinants of health. Overdose risk reduction strategies for those at the highest risk for overdose death need to move beyond risk behavior reduction education and address structural determinants of health.

Details found at clinicaltrials.gov, NCT02093559.