Intersectionality and Structural Drivers of Fatal Overdose Disparities in the United States: a Narrative Review

Abstract

Abstract Purpose of Review Disaggregated data has increasingly confirmed the persistence of racial and ethnic disparities in fatal drug-related overdose in the United States. Less is known about additional disparities or how they interact to exacerbate mortality. Utilizing an intersectional framework, we reviewed literature on fatal overdose disparities and potential structural drivers. Recent Findings Most published studies document overdose disparities by race and ethnicity; research examining other identity-based and sociodemographic disparities (e.g., gender, sexuality, lifecourse stage, disability) is emerging but more limited. Some studies point to potential structural drivers of disparities (e.g., housing, law enforcement interactions, employment, prevention and treatment service access), yet major data limitations inhibit complex research. Nevertheless, intervention and implementation strategies to reduce overdose exist. Summary An intersectional framework helps explore how marginalization and unequal access to financial resources, power, legal rights, and services drive fatal overdose disparities while illuminating promising strategies that warrant additional, rapid research.