Background and aims:

Opioid-related overdose death rates continue to rise in the United States, especially in racial/ethnic minority communities. Our objective was to determine if US municipalities with high percentages of non-white residents have equitable access to the overdose antidote naloxone distributed by community-based organizations.

Methods:

We used community-based naloxone data from the Massachusetts Department of Public Health and the Rhode Island Non-Pharmacy Naloxone Distribution program for 2016–2018. We obtained publicly available opioid-related overdose death data from Massachusetts and the Office of the State Medical Examiners in Rhode Island. We defined the naloxone coverage ratio as the number of community-based naloxone kits received by a resident in a municipality divided by the number of opioid-related overdose deaths among residents, updated annually. We used a Poisson regression with generalized estimating equations to analyze the relationship between the municipal racial/ethnic composition and naloxone coverage ratio. To account for the potential nonlinear relationship between naloxone coverage ratio and race/ethnicity, we created B-splines for the percentage of non-white residents; and for a secondary analysis examining the percentage of African American/Black and Hispanic residents. The models were adjusted for the percentage of residents in poverty, urbanicity, state, and population size.

Results:

Between 2016–2018, the annual naloxone coverage ratios range was 0–135. There was no difference in naloxone coverage ratios among municipalities with varying percentages of non-white residents in our multivariable analysis. In the secondary analysis, municipalities with higher percentages of African American/Black residents had higher naloxone coverage ratios, independent of other factors. Naloxone coverage did not differ by percentage of Hispanic residents.

Conclusions:

There appear to be no municipal-level racial/ethnic inequities in naloxone distribution in Rhode Island and Massachusetts, USA.