Last year I posted Talking To Your Kids: Know The Facts. Be Prepared. Seek Help. emphasizing the seriousness of teenage opioid and fentanyl use and the risks of overdose deaths. The post was written from my perspective as a parent of teenagers, but also as a psychiatrist; making sure that readers knew the facts, were prepared, and knew how to seek care.
Over the intervening months I have grown increasingly concerned about these issues and the specific challenges facing Latino/Hispanic youth. In this blog, my hope is to further underscore the importance of addressing this issue from the lens of a healthcare provider and advocate.
In 2020 SAMHSA published, The Opioid Crisis And The Hispanic/Latino Population: An Urgent Issue, highlighting recent data, contextual factors and culturally attuned outreach and engagement strategies. Since the COVID-19 pandemic we have seen overdose deaths rising rapidly among Black and Latino/Hispanic communities and we all know that the pandemic exacerbated a range of health, social, and economic issues, particularly among racial and ethnic minoritized communities.
The recent data on substance use and overdose deaths among Latino/Hispanic adolescents and young adults in the United States points to several worrisome trends:
Approximately 1.8 million Latino/Hispanic youth (12 years+) had misused opioids in the prior year. SAMHSA, NSDUH 2020
Opioid misuse is primarily driven by prescription pain reliever misuse. SAMHSA
Less than 10% received treatment in a specialty facility. SAMHSA
Unintentional drug overdose death rates among U.S. youth aged 15-19 has remained elevated and this increase was primarily driven by substances like fentanyl.
Overdose rates among Hispanics increased dramatically from 5.6 to 21.7 per 100,000, marking a 287.5% increase (from 2010 to 2021).
These statistics highlight the growing public mental health emergency of substance use and overdose deaths. They also stress the need for culturally tailored prevention and treatment interventions and resources to address this crisis within the Latino/Hispanic community, especially among adolescents and young adults. Additionally, these findings are crucial for healthcare providers and policymakers in designing and implementing effective interventions for this population.
The available data on SUD among Latino/Hispanic youth in the United States underscore several important aspects and challenges that must be addressed. Research shows that Hispanic/Latino cultures [note: this term encompasses a very heterogenous and diverse community] possess many rich cultural values and strengths that can be protective factors against SUD and overdose. For example, the emphasis on the value of family and respect within Hispanic communities play a vital role in developing and promoting treatment interventions based on family system models and involvement of family members throughout the different prevention and treatment phases of care.
Research indicates that immigration and the added stressors of acculturation have an impact on overall mental health. Discrimination, trauma, stigma, fear and lack of medical insurance, in many instances, constitute significant stressors that contribute to less-than-optimal health seeking behavior and outcomes.
Another significant challenge in addressing SUD in the Hispanic/Latino community is the dearth of Latino/Hispanic healthcare workers, which exacerbates language barriers and cultural misunderstandings. This paired with limited culturally responsive prevention and treatment offerings and lower access to Medication-Assisted Treatment (MAT) creates overwhelming health inequities for those struggling with SUD.
As healthcare providers, especially those who care for Latino/Hispanic patients and/or caregivers, and regardless of primary or specialty setting, it is imperative to aware of the many programs and initiatives, as well as policy changes, that address substance use disorders and overdose prevention in Latino/Hispanic communities. Many of these interventions are designed to enhance the capacity and competencies of healthcare providers to effectively manage and treat substance use disorders.
RECENT INITIATIVES AND POLICY CHANGES
The Biden-Harris Administration, through HHS, continues to fund the Overdose Prevention Strategy. These funds are aimed at primary prevention, evidence-based treatment, harm reduction, and recovery support services, with an emphasis on improving the nation's behavioral health infrastructure. The Overdose Prevention Strategy also involves removing barriers to buprenorphine prescribing and lifting the moratorium on mobile components for opioid treatment programs to reach rural and underserved communities. |
Approximately $3B from the American Rescue Plan has been allocated to expand access to mental health and substance use disorder services. This includes a historic $30M for harm reduction services such as enhancing syringe services programs. |
The Administration has extended emergency provisions from the COVID-19 pandemic for Medication for Opioid Use Disorder (MOUD) authorizations, allowing treatment to begin via telehealth, including audio-only services. SAMHSA has also extended methadone take-home flexibilities for an additional year. To read more about these changes, check out my posts: Breaking Barriers: The Telehealth Transformation of Opioid Treatment and Game-Changers: Expanding Access to SUD Treatment in 2024. |
The CDC has launched education campaigns about the dangers of fentanyl, the risks of mixing drugs, and the importance of reducing stigma around drug use to support treatment and recovery. SAMHSA provides a variety of resources and programs, such as the Overdose Prevention and Response Toolkit, which includes guidance on opioid overdose reversal medications and how to respond to an overdose. These campaigns serve as practical resources for healthcare providers in educating themselves, their patients, and communities. |
In 2021, HHS released new Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder exempting eligible healthcare providers from federal certification requirements related to training and counseling, simplifying the process for obtaining a waiver to treat up to 30 patients with buprenorphine and thus expanding access to evidence-based treatment by making it easier for providers to prescribe buprenorphine. |
In 2021, the DEA finalized measures to lift a decade-long moratorium on opioid treatment programs that wanted to include a mobile component in order to provide treatment to rural and other underserved communities, including incarcerated individuals. |
The CDC and SAMHSA announced that federal funding may now be used to purchase fentanyl test strips. This initiative is part of an effort to help curb the dramatic spike in drug overdose deaths. It provides healthcare providers with additional tools to prevent overdoses, particularly in communities heavily impacted by fentanyl use. |
These initiatives and interventions are part of a broader strategy to empower healthcare providers with the resources, funding, education, and policy support needed to effectively address substance use disorders and prevent overdoses, with a particular focus on serving diverse and underserved communities, including the Latino/Hispanic population.
PREVENTION, SUPPORT, AND TREATMENT OPTIONS
Healthcare providers should also be aware of the various current prevention, support, and treatment options specifically tailored for Latino/Hispanic youth dealing with substance use disorders and overdose risks. Prevention, support, and treatment options for Latino/Hispanic youth with substance use disorders and overdose risks encompass a variety of approaches, including culturally tailored programs and community-based interventions.
Research has shown that family involvement in a youth's education and promoting their personal agency can prevent or reduce substance use. Family-based programs, particularly those focusing on adolescents, are effective in this regard, showing reduction in the likelihood and frequency of substance use.
Here are a few examples:
Based on the understanding of Latino/Hispanic culture and family as well as parenting factors, family-centered interventions such as the Brief Strategic Family Therapy (BSFT) have shown to be effective at preventing or reducing substance use among Latino youth. The BSFT program focuses on supporting the family structure, tracking family interaction patterns, and assisting in redirecting any maladaptive interactions while fostering open and effective communications.
Familias Unidas is a family-centered intervention that has been shown to be effective at reducing substance use and risky sexual behaviors among Latino/Hispanic youth. The program provides parents with education on protective and risk factors, enhances parental skills, improves parent-adolescent communication and works on increased parental involvement and investment in their child’s lives.
Familias Unidas is structured around the family (but also includes peers and school network) dynamics with facilitated individual and group meetings using participatory learning methods to help improve parental investment and support, home visits to address negative interactions within the family (as well as peer and school networks), family supervised activities and family homework assignments to practice parenting skills.
Celebrating Families! (CF!) is another family-centered model that has shown promise in addressing substance use disorders in the Hispanic community program. It is recognized as one of the few evidence-based family-focused practices listed on the Substance Abuse and Mental Health Services Administration’s National Registry of Evidence-Based Programs and Practices.
The CF! program is designed to engage every member of the family and uses a multifamily, skill-building model. It aims to increase family resilience and improve parents' social and cognitive skills, which are crucial in combating substance use disorders. An adaptation of this program for Hispanic families, known as ¡Celebrando Familias!, has been found to be as effective in Hispanic communities as the English version is with English speakers. The effectiveness of CF! in Hispanic communities has been demonstrated through studies that compared Hispanic families' outcomes in the program with those of non-Hispanic families. These studies indicate that a family-centered treatment model like CF! can be an effective intervention for Hispanic clients, particularly when it involves culturally adapted interventions.
Culturally adapted, family-centered interventions like Familias Unidas and ¡Celebrando Familias! have shown effectiveness in addressing substance use disorders in the Hispanic/Latino community. These programs highlight the importance of family resilience, parental skills, and the cultural adaptation of interventions to meet the specific needs of the community.
We must confront the growing challenges of substance use disorders and overdose risks among Latino/Hispanic youth with an immediate and coordinated response that includes healthcare providers, policymakers, and community leaders. It is critical that we leverage our understanding of the pivotal role of family and cultural values in this demographic as powerful protective factors. We must develop, implement, and scale up more culturally attuned, family-centered, and community-based prevention and treatment options.
I strongly believe that these concerted efforts, across many stakeholders, can help address the current crisis but also lay down a sustainable framework for future initiatives in Latino/Hispanic communities that ultimately lead to healthier, more resilient youth.
* In this post (and as referenced in SAMHSA publications) Hispanic/Latino is used as an umbrella term to include those who identify as “Hispanic,” “Latino,” and/or “Latinx” in the U.S. This typically includes individuals with ancestral origins from Latin America and/or Spain.
RESOURCES:
Hispanic/Latino Behavioral Health Center of Excellence (H/L CoE) is focused on:
(1) developing and disseminating culturally informed, evidence-based behavioral health information;
(2) providing training and technical assistance (TTA) on evidence-based and best practices in mental health promotion, prevention, and treatment and recovery from mental health and substance use disorders; and
(3) expanding the behavioral health workforce for Hispanic and Latino communities.
National Center on Substance Abuse and Child Welfare (NCSACW) provides a number of resources and information tailored to the needs of Latino/Hispanic youth dealing with substance use disorders:
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