Attitudes Toward Opioid-Related Service Needs: Do Social Determinants of Health Matter?

Background and Purpose: In the US, more than 168 million opioid prescriptions were filled in 2018, and opioid-involved overdose deaths increased 3.8 times from 2010 to over 80,000 in 2021. Literature has reported that positive attitudes toward opioid treatment services were critical in encouraging service utilization, while the attitudes that promote risky use of substances have stymied the implementation of interventions and public policy initiatives. Overall, Alabama presented the highest rates of filled opioid prescriptions (97.5 per 100 persons). To provide community-based services to improve access to opioid prevention and treatment services for Alabama residents, it is imperative to investigate the factors that affect personal attitudes toward opioid-related service needs (PAON). Grounded in the social determinants of health (SDH) framework, this study aimed to investigate the factors associated with PAON.

Methods: Using a survey research method, a sample of 191 African American residents of Alabama’s Black Belt region, aged 18 years or older, were recruited through a convenient sampling technique. The dependent variable, PAON, was obtained by summing responses to three items that asked the degree to which they agreed with the needs for community education on opioid knowledge and overdose response measures and the needs for transportation support for prevention, treatment, and recovery services (0 = strongly disagree to 4 = strongly agree). A higher score indicates stronger agreement with the needs. Seven SDH factors (food insecurity, social isolation, intimate partner violence (IPV), social media access, transportation access, socioeconomic status (SES), and housing stability) and demographic factors (age, gender) were included as independent variables. Multiple linear regression modeling was performed to examine the factors associated with PAON.

Results: About 60.8% of respondents were 55 years or older, and 68.1% were female. A medium level of food insecurity, a moderate level of social isolation, low levels of IPV, social media access, and household transportation use, and a medium level of SES were observed. A high level of PAON was reported for the communities. The multiple linear regression model indicated that the combination of independent variables accounted for about 21% of the variance in PAON. Age was positively associated with PAON (p <.001). SDH and IPV were negatively associated with PAON (p <.05). Social media access (p <.05) and SES (p <.05) were positively associated with PAON.

Conclusions and Implications: These findings indicate that people who are older, who experience less IPV, who frequently use social media, and who have higher SES are likely to have heightened awareness of the significance of the opioid use problem and to be more engaged in preventing and reducing it in the community. Healthcare professionals should develop education programs and targeted interventions, particularly for those who are younger, isolated from social media, and have low SES. Outreach programs are recommended for individuals experiencing IPV in remote rural areas because of the increased challenge in seeking help for substance misuse. Future studies should aim to clarify the necessary opioid-related information to enhance knowledge of opioid use disorders and help-seeking behaviors.