Place-based harms and hidden strengths: a qualitative study exploring facets of neighborhood disinvestment driving opioid overdose among black individuals

Background: Despite significant efforts to address the opioid overdose crisis, Black people who use drugs (PWUD) face unabating, disproportionate increases in opioid overdose death (OOD) rates. These inequities persist in treatment admissions, utilization of medication for opioid use disorder, and treatment retention. Research has linked neighborhood disinvestment — a process of urban decline driven by policy-related changes in neighborhood demand and desirability leading to decreased population, physical and economic erosion, and poorer quality of life for residents — to increased rates of OOD. However, given recent increases in OOD inequities, more research is needed to determine the specific aspects of neighborhood disinvestment that drive OOD risk among Black PWUD. Methods: The current qualitative study utilized a community-engaged research approach to conduct focus groups with stakeholders providing support to PWUD in Black neighborhoods in order to identify the facets of neighborhood disinvestment that contribute and mitigate increases of OOD among Black PWUD in St. Louis, Missouri. Results: The resulting thematic analysis identified four themes linking neighborhood disinvestment to increased rates of OOD among Black PWUD: (1) a lack of access to congruent treatment and services, (2) intergenerational and socioemotional lack of mobility, (3) lack of financial accountability and investment from local leadership and government, and (4) the loss of collective community responsibility and engagement. A fifth theme brought attention to a culturally-grounded strategy being used to reduce these rates: (5) building engagement and community cohesion through grassroots efforts and street outreach. Conclusions: Findings provide key implications for policy and practice, including the importance of adopting a community-based research framework, offering financial management training for Black-led organizations, and harnessing community champions to implement culturally-tailored interventions aimed at reducing stigma and raising critical consciousness. Future work should aim to identify more effective community-driven solutions to address OOD in Black neighborhoods.