Characterizing Communities Vulnerable to Opioid Addiction

Over the last decade, Ohio has experienced a dramatic and unprecedented increase in opioid use. The impact of the opioid epidemic in the state has been nothing short of catastrophic. Fatal overdoses involving prescription opioids and heroin have skyrocketed from 296 in 2003 to 2,590 in 2015. Although opioid dependency and overdose has increased nationally, Ohio is the epicenter of the opioid crisis, leading the nation in overdose deaths due to opioids in 2014 and 2015. The scope and trajectory of the epidemic call for urgent attention to understanding the origins of place- and individual-level vulnerability to opioid dependency and its health consequences. Identifying the community-level factors that render a place vulnerable to increased opioid use will aid in targeting interventions to ensure that spread of the epidemic is contained and the prevalence of opioid use ultimately reduced. We argue that exposure to declining economic conditions in rural areas of Ohio has spawned a collective sense of economic abandonment and cynicism in some communities, resulting in independent impact on vulnerability to opioid use.

The goals of this project are twofold. First, we will create an integrated dataset that can be used to examine opioid outcome in pregnant women in Ohio. We will use 2008-2015 Ohio Medicaid claims and enrollment data and 2008-2015 Ohio birth data to investigate the multilevel determinants of two outcomes: chronic opioid dependency and neonatal abstinence syndrome (NAS). These data are linked with American Community Survey and Census data to capture contemporaneous and lagged economic conditions at the county and census tract levels. We will also integrate data on other structural environmental factors such as the location of: mental health and substance abuse providers, programs, clinics and hospitals; organizations such as food pantries, community centers, YMCAs and shelters; churches or synagogues; WIC and food stamp offices; and food deserts. The second goal of the project is to conduct a preliminary survey on a sample of 30 Ohio communities (counties) which pilots measures of economic cynicism and spatially clustered sampling strategies. Focusing primarily on counties outside the major metro areas of the state where opioid risk is elevated, we will sample predominantly economically distressed communities with varying levels of opioid use. We will then evaluate the “eco-metric” properties of our proposed aggregate measure of economic cynicism and estimate the extent of variation in this measure across our sample of predominantly lower (but still variable) income communities. We will then calculate preliminary estimates of the strength of association between baseline measures of economic conditions, economic cynicism, and opioid use outcome rates, testing the hypothesis that economic cynicism explains variation in opioid use outcome rates and partially mediates any observed effects of economic conditions. These two objectives will inform the development of a proposal to the National Institute on Drug Abuse in February of 2018.
 

Given the magnitude and increasing trajectory of the opioid epidemic, there is need for innovative research which rethinks the reasons that certain communities appear to be particularly vulnerable to opioid addiction. This study provides a more nuanced understanding of multilevel risk profiles for opioid use than is currently available. Findings from the study will aid in more effective targeting of substance abuse programs to vulnerable communities and the at-risk individuals within those communities.