A Scoping Literature Review of Substance Use in Hawaii

Background and Purpose: Substance use is a significant social work and public health issue. The annual average prevalence of past-year substance use disorder reported by the National Survey on Drug Use and Health during 2017-2019 was 8.4% (or 97,000) among people aged 12 or older in Hawai'i, slightly higher compared to the national average (7.4%). Substance use issues in Hawai'i are more severe among the state's neighboring islands due to high prevalence and unmet service needs; Native Hawaiians have a higher prevalence of substance abuse compared to other ethnic groups; and sexual and gender minority adults and youth are more likely to use substances than their counterparts. Literature about the high-need areas and affected vulnerable groups are scattered and limited. We conducted a scoping review to identify and synthesize existing literature on substance use in Hawai'i.

Methods: We conducted a scoping review using the 2018 Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) Checklist. We searched three databases, PubMed, Web of Science, and CINAHL, for 2010-2023. The titles and abstracts were searched using the following keywords: Drug, alcohol, and substance use/abuse/misuse, behavioral health, methamphetamine, marijuana, cocaine, heroin, ecstasy, hallucinogens, inhalants, prescription drugs, opioid, meth, addiction, and Hawaii/Hawaiʻi. We also identified government and other reports through a manual search. The exclusion criteria include the absence of a substance use focus, policies/reviews/brochures/newsletters/reviews/historical/pharmacological documents, unable to access full-text articles, and conducted outside of the U.S.

Results: The database and a manual search yielded 688 and 13 documents, respectively. After removing duplicates and excluding documents based on exclusion criteria, 21 documents were included in our final synthesis. Our synthesis generated four categories: geography/location, age/age range, race/ethnicity, and vulnerable populations. Most documents included state and county-level data. Eighteen documents reported data on individuals under or over the age of 18. Thirteen documents reported data on Native Hawaiians, followed by Native Hawaiian or Pacific Islander, Samoan, and Other Pacific Islanders. Filipino and Japanese were the most reported Asian categories. Most documents included White as a category, seven included Black or African American, and two included American Indian/Alaska Native. Some documents included categories such as Portuguese, Hispanic, Latino, Spanish, and mixed races/ethnicities. Vulnerable populations found in the review include sexual gender minorities, pregnant/parenting women, homeless, justice system-involved individuals, and victims of sexual and intimate partner violence.

Conclusions and Implications: Our findings show that comprehensive literature reports data at the state level, diverse race/ethnic groups, and youth groups under 18. There needs to be more literature and data on substance use in community-level geography and among the aging population. Future research that focuses on community-level geography data and the aging population may fill gaps in the literature. It will allow professionals and community members to build on existing strengths and identify specific needs and resources. It would also allow for tailored and culturally appropriate substance use prevention, treatment, and recovery services.