This study uses group-based multi-trajectory models and path analysis to assess relations among neighborhood opioid-overdose death trends, drug type compositions, and socioeconomic neighborhood characteristics across Delaware from 2013 to 2017.
Increases in opioid overdose deaths have been pronounced throughout the nation. The current narrative about them stresses their reach into middle-class America while theories that link substance use etiology and drug markets, such as availability-proneness theory, suggest that lower-income communities should be most impacted. The latter might be especially true due to the increased involvement of cheap and highly potent fentanyl. We find support for availability-proneness theory, insofar as drug availability and substance use are associated with neighborhoods in the trajectory groups with the highest overdose death rates. Moreover, we find that neighborhood disadvantage is associated with increased drug availability as well as substance use. Our results also suggest that open-air drug market access might be associated with an increased risk of fentanyl and heroin exposure which, in turn, can lead to spikes in overdoses net of other risk factors. Overall, our findings reveal the social character of the opioid epidemic and inform the literature on social inequality and drug use. We highlight the need for community reinvestment and harm reduction strategies to alleviate the drug problems in the most disadvantaged communities. (Publisher abstract provided)