Project Title: Multi-Sector and Multi-Level Community-Driven Approaches to Remove Structural Racism and Overdose Deaths in Black Indianapolis Communities (MACRO-B)
Indiana University (Project Director: Dong-Chul Seo), Overdose Lifeline, Inc. and community-based partners propose to conduct MACRO-B Project to develop and implement new policies and practices to remove structural racism around overdose prevention and response, and achieve a >25% decrease in opioid-involved overdose deaths in the target community.
There is an ongoing opioid overdose crisis in the U.S. and growth in fentanyl-related overdose deaths in Blacks outpaces that of Whites in Indianapolis, Indiana, and across the nation. Fentanyl-related overdose deaths in Indianapolis increased more than 700% from 86 in 2016 to 641 in 2021 and the proportion of Blacks in these fatal overdoses increased from 19% in 2016 to 29% in 2021 whereas that of Whites decreased from 79% in 2016 to 70% in 2021. The annual overdose death count continues to rise, and Black Americans are disproportionately affected.
Evidence is emerging that structural racism is part of the problem. There are racial and neighborhood disparities in life-saving naloxone distribution. In 2019, greater than 75% of fatal opioid-involved overdoses in 37 states had no evidence of naloxone administration and structural racism is preserved in opioid overdose education and response. Discretionary nature of drug law enforcement coupled with fears of legal consequences among many Black opioid users, misinformation about overdose and naloxone, and stigmatizing beliefs are major factors that perpetuate racial disparities, contributing to a disparate burden of overdoses among Blacks.
The project will be implemented within four zip code areas (46202, 46205, 46208, & 46218) in inner-city Indianapolis, Indiana, experiencing a disparate burden of opioid-involved overdose events and deaths. The target audience includes 100,082 residents.
For rigorous evaluation of outcomes, the project will use a parallel, cluster-matched, quasi-experimental design with pre- and post-measurements. Four other zip code areas of Indiana (46408, 46410, 46628, and 46806; N=104,446 residents) have been selected as the comparison community by using four zip-code-level matching variables such as Black racial proportion, families living in poverty, population size, and proportion of children who are eligible for free/reduced lunch.
The project team has secured commitments from various grassroots community partners, Black community residents who are overdose survivors or family members of fatal overdoses, law enforcement, local emergency medical services, decision-makers at local and state governments, and local and state-level legislators, in order to form MACRO-B Coalition. The Coalition will meet monthly and its subcommittees quarterly, to serve as the main force to identify and revise problematic policies and practices that contribute to structural racism around overdose prevention and response.
For data-based approaches, we will conduct background research on legal/structural racism topic and create an environmental scan; key informant in-depth interviews and focus groups; and community overdose knowledge, attitude, discrimination, and stigma (OKADIS) surveys through community probability sample surveys. We will provide monthly educational programming and naloxone boxes that are mounted to walls in public places to improve the capacity of bystander rescuers to save the lives of victims of opioid overdose. Through town hall meetings, focus groups, and seminars that are organized in Project Years 2 and 3, we will pursue broad community consensus building, follow-up initiatives to sustain MACRO-B initiated activities, and wide dissemination of project results to remove structural racism around overdose.
