Neglected in an overdose crisis: Drug use treatments targeting Asian American, Native Hawaiian and Pacific Islander communities
In the escalating overdose crisis, increasing attention has shifted to racial and racial disparities in the accessibility of drug-assisted treatments such as buprenorphine. Most existing studies focus on the differences found in MAT among Black and Hispanic patients. In contrast, Asian American, Native Hawaiian, and Pacific Islander (AANHPI) communities remain significantly studied and are often overlooked due to systemic barriers and stereotypes. Research by Chhabra et al. In the United States, approximately 1.1 million opioid-related emergency department (ED) encounters were analyzed, highlighting differences in buprenorphine prescriptions for race, gender, and clinical factors. Most notably, Asian American (AA) and Hawaiian World/Pacific Islander (NHPI) patients were less likely to receive buprenorphine compared to white patients, with adjusted odds ratios of 0.85 (95% CI: 0.79-0.91) and 0.79 (95% CI: 0.71-0.89), respectively. This has made an important contribution to understanding the access to racialized access to MAT, especially through the use of taxonomic data on race and encountering opioid use disorder (OUD) studies.
Situating these differences within a broader socio-political and cultural framework is critical to feasible changes. Despite elevated overdose, Aanhpis remains insufficient in the national discussion on drug use disorders. The omission reflects the lasting impact of the “model minority” myth, a stereotype that portrays Aanhpi’s individual unification success and isolates itself from social and health challenges, including addiction. This narrative masks serious health risks, including SUD, and fails to acknowledge the drug overdose deaths of AANHPI between 2018 and 2022, with the number of overdose deaths of NHPI increasing to 5.9 per 100,000 in Asian Americans; methamphetamine leads 100,000 at a rate of 11.4 vs. 2.0 in NHPI. However, national surveillance systems often define the AANHPI community as a uniform low risk, while datasets such as state drug use and health and treatment plot datasets may report Asian American and NHPI data respectively, but are rarely further classified by ethnic subgroups, limiting considerable visibility to substance use and treatment in substance use substances.
These challenges reflect the ever-influence of life experiences people have about the language, culture and trust of the healthcare system. The multifaceted obstacles faced by the AANHPI community can go beyond clinical manifestations. National data systems such as NSDUH are only conducted in English and Spanish, thus not including many people with limited English skills, especially older people and Aanhpi immigrants. Cultural perceptions and stigma surrounding substance use are rooted in concerns about shame and moral failure, and are unwilling to seek treatment. Fears associated with immigration, the lack of racially consistent providers, and culturally inappropriate perceptions of the service may further reduce participation. Therefore, it is estimated that 60% of NHPI individuals who avoid or delay treatment are NHPI individuals.
To translate evidence into equity, interventions can not only be available, but also accessible, acceptable and culturally adjustable. Therefore, there is an opportunity to implement culturally responsive link programs in ED and primary care settings. Health systems should prioritize ensuring access to interpreters and integrating peer navigation personnel from the AANHPI community. For example, Asian women’s action (awareness) pilot study on resilience and empowerment shows that providing culturally tailored, traumatic group therapy for Asian American, Korean and Vietnamese descent solves problems such as international trauma, internalized stigma, and internalized racism. These efforts are in line with priorities outlined by the U.S. Department of Health and Human Services (HHS), including providing appropriate cultural care, breaking down data, and reducing health inequality through community participation. Efforts to expand access to Oud treatment must include the AANHPI community, recognizing structural challenges and unique cultural dynamics that shape their care needs.
Despite new research, there are still key gaps in understanding OUD studies in the Aanhpi population. Future research has the opportunity to conduct cross-analysis that can better reflect the wide diversity of the AANHPI population, study the burden of substance use disorders in specific ethnic subgroups, as well as factors such as language, immigration status and generational experience. Policy development should also prioritize culturally sensitive prevention and treatment programs, such as integrating interpreting services and equity indicators into federal and state drug use programs; it will increase the impact of the Aanhpi community. Importantly, researchers and policy makers must challenge the default framework and stereotyped minority mythological mentality, which uniformly classifies the Aanhpi community as low risk, thus hindering visibility and resource allocation.
As the overdose crisis develops, so must the framework to support equity and diversity in clinical settings. Stakeholders, including clinicians, researchers, community leaders and policy makers, all have vital opportunities to expand access to culturally responsive evidence-based addiction care models to improve health equity in the AANHPI community. Meeting this critical gap requires collaborative action from all parties to ensure that the AANHPI community is not only visible in the data, but is crucial to the future of equitable addiction care.
Image source: Andrii Shyp, Getty Images
Imeth Illamperuma is an undergraduate student at McMaster University, with a certificate in researching kinesiology, assisted psychology and rehabilitation science. He has extensive experience in public health research and policy advocacy through affiliation with the Center for Addiction and Mental Health (CAMH), McMaster University and Boston University’s Department of Medicine. His work focuses on many topics, including harm reduction, youth mental health, and the integration of artificial intelligence in clinical decision-making. Imeth is the founder and president of Shield and the founder of Naloxone Project, one of Canada’s largest student-led emergency Naloxone implementation and advocacy programs. He is committed to advancing evidence-based, equity-driven approaches to healthcare systems design and utilization.
Suhanee Mitragotri is an undergraduate at Harvard University, a middle school that studies neuroscience, which is global health and wellness policy. She is also the co-founder of the Naloxone Education Program, which aims to expand opioid and naloxone education to youth. She has written about topics related to the opioid crisis, harm reduction and drug policy and has published articles in a variety of journals and magazines, including the Lancet Regional Health America, Addiction, Frontiers in Health Affairs, The Boston Globe and New Scientist.
David T. His research focuses on drug use disorders, clinical epidemiology, health economics, and social determinants of health. His work has been published in major journals including the Lancet, the Lancet Regional Health America, Jama Network Open, Jama Psychiatry, Natural Science Reporting and the Journal of Injury Reduction. David’s contribution to addressing the overdose crisis has been recognized by several foundations, including the Diana Award, the Boston Public Health Conference under 40 Public Health Under 40, the National Forum on the Quality of Minority Under 40, and the U.S. Public Health Award for Excellence in Public Health.
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