Evaluating equity in community-based naloxone access among racial/ethnic groups in Massachusetts

Shayla Nolen, Xiao Zang, Avik Chatterjee, Czarina N. Behrends, Traci C. Green, Benjamin P. Linas, Jake R. Morgan, Sean M. Murphy, Alexander Y. Walley, Bruce R. Schackman, Brandon D.L. Marshall

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Background: Racial/ethnic minorities have experienced disproportionate opioid-related overdose death rates in recent years. In this context, we examined inequities in community-based naloxone access across racial/ethnic groups in Massachusetts. Methods: We used data from: the Massachusetts Department of Public Health on community-based overdose education and naloxone distribution (OEND) programs; the Massachusetts Office of the Chief Medical Examiner on opioid-related overdose deaths, and; the United States Census American Community Survey for regional demographic/socioeconomic details to estimate community populations by race/ethnicity and racial segregation between African American/Black and white residents. Race/ethnicity groups included in the analysis were African American/Black (non-Hispanic), Hispanic, white (non-Hispanic), and “other” (non-Hispanic). We evaluated racial/ethnic differences in naloxone distribution across regions in Massachusetts and neighborhoods in Boston descriptively and spatially, plotting the race/ethnicity-specific number of kits per opioid-related overdose death per jurisdiction. Lastly, we constructed generalized estimating equations models with a negative binomial distribution to compare the race/ethnicity-specific naloxone distribution rate by OEND programs. Results: From 2016–2019, the median annual rate of naloxone kits received from OEND programs in Massachusetts per racial/ethnicity group ranged between 160 and 447 per 100,000. In a multivariable analysis, we found that the naloxone distribution rates for racial/ethnic minorities were lower than the rate for white residents. We also found naloxone was more likely to be distributed in racially segregated communities than non-segregated communities. Conclusion: We identified racial/ethnic inequities in naloxone receipt by individuals in Massachusetts. Additional resources focused on designing and implementing OEND programs for racial/ethnic minorities are warranted to ensure equitable access to naloxone.

Original languageEnglish (US)
Article number109668
JournalDrug and alcohol dependence
StatePublished - Dec 1 2022
Externally publishedYes

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© 2022 Elsevier B.V.


  • Naloxone distribution
  • OEND
  • Opioids
  • Overdose
  • Racial inequity


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