Abstract
Description
The opioid crisis poses a substantial threat to youth throughout the nation. This crisis has been exacerbated by the COVID-19 pandemic, reversing some of the positive national trends in the fight against the opioid epidemic. Some risk factors for youth opioid use have been identified nationally. The South Florida tri-county region of Miami-Dade, Broward and Palm Beach is a culturally distinct region which may not follow national trends and likely has unique risk and protective factors. To address the concerning spike in youth opioid use in South Florida, a community coalition was formed to identify factors unique to South Florida and create a plan for early awareness and prevention.
Keywords: opioid-related disorders, opioid-related disorders/epidemiology, opioid-related disorders/prevention and control, substance-related disorders, opiate overdose, risk factors, adolescent, epidemics, pandemics
The Opioid Epidemic Is a National Crisis
The opioid epidemic presents a complicated and multifaceted crisis. Nationally, over half a million people died due to opioid-related drug overdoses between 1999 and 2019.1 The crisis has been further exacerbated by the COVID-19 pandemic. While the numbers improved slightly toward the end of this period, any gains made have been offset due to COVID-19, resulting in the highest number of annual overdose deaths ever recorded.2 Nationwide in 2017, there were over 170,000 children who suffered from opioid use disorder (OUD) or accidentally ingested opioids.3 Over half of adults treated for OUD began using opioids before the age of 25, thus one of the major avenues for improvement is the early awareness and prevention of opioid abuse in youth by identifying and addressing risk and protective factors.4
Florida Youth Are at Risk
Florida is uniquely diverse. It has one of the largest African American populations in the country and has the second highest Latino population on the East Coast outside of New York. The ethnic Asian population has grown rapidly and the state has several federally-recognized American Indian tribes, including the Seminole and Miccosukee. The tri-county region of South Florida, made up of Miami-Dade, Broward and Palm Beach counties, is an epicenter for population growth and demographic diversity.5 This diversity contributes to an essential multiculturalism that adds distinct dimensions to the youth opioid problem in South Florida.
The problem is worsening in South Florida. In Miami-Dade County, the number of youth opioid overdoses in 2016 and 2017 was more than four times greater than the number of overdoses in 2010.6 In Palm Beach County, the use of non-pharmaceutical fentanyl and the misuse of prescription opioids has increased dramatically.7 In Broward County, the number of heroin-related deaths increased by 125% between 2015 and 2016.8
The ongoing challenges of the opioid crisis were exacerbated by COVID-19. Nearly every state reported an outbreak of overdoses and an increase in OUD during the pandemic, and Florida was no exception.9 Florida Governor Ron DeSantis reported a 62% increase in opioid overdoses near the start of the pandemic.10 As vaccine distribution increases and the viral landscape in Florida improves, there is a significant amount of work to improve awareness and prevention of opioid abuse in South Florida youth.
Risk Factors for Opioid and Substance Abuse
Adolescence is a critical time to understand the risk factors that influence a person’s likelihood to abuse opioids and other addictive substances. Adolescents who initiate prescription opioid misuse are more likely to demonstrate OUD than those who misuse opioids later in life.11 Risk factors are present before substance use occurs and may coincide with or continue after initiation of substance use. Likewise, identification of risk factors in youth can direct early interventions to reduce the development of OUD in adulthood. Risk factors of substance abuse are classified as behavioral, environmental and biochemical/neurological. They may be genetic, influences on extrinsic and intrinsic behavior, or developmental (personal values and attitudes towards substance abuse).
Racial/Ethnic Minorities
The literature suggests that differences regarding substance abuse may be linked to racial and socioeconomic disparities.12 Studies indicate that African American adolescents have the highest prevalence of adolescent prescription opioid misuse.13 A relationship between community violence and African-American adolescent male marijuana use has been previously established, and stressful environments may further exacerbate substance abuse for these youth.14 The impact of an adolescent’s race on substance choice is understudied and inadequately characterized in the South Florida region.
Gender/Sexual Minorities
Risk of substance abuse is also elevated among the LGBTQ population across several types of substances.15 Elevated rates of substance use in the LGBTQ community have been posited as a coping mechanism to manage minority stress. Minority stress theory suggests that imbalances in social power produce physiological and psychological health disparities in minority groups.16 Experiences such as discrimination, victimization and internalized homophobia can exacerbate substance use among LGBTQ youth.17 LGBTQ youth who are more open and more visibly expressing their sexuality and gender identities face a higher risk of direct stigma.18 All of these issues negatively impact the LGBTQ community, increase substance abuse and deserve more attention.
Protective Factors and Adolescent Substance Abuse
Protective factors are characteristics, skills, support systems and opportunities associated with the absence of a problem such as substance abuse. Protective factors exist before or in parallel with abstinence from substance use. Protective factors are not the opposite of risk factors but rather reduce the impact of the risk factors. Environmental protective factors include familial and parental support,19 boundaries,20 high expectations and empowerment. Individual protective factors include an internal locus of control,21 high self-esteem,22 hopefulness,23 parental attachment,24 commitment to learning and a sense of purpose.25 High levels of protective factors may attenuate some of the negative impacts of parental substance exposure on substance use.26
A Call to Action
We posit that while risk and protective factors are well-characterized in the literature at a national level, there is a paucity of evidence concerning the risk and protective factors influencing the opioid epidemic among South Florida youth, where there is heightened diversity along ethnic, socioeconomic, and gender/sexual dimensions. The region is in dire need of educational interventions focused on prevention and awareness campaigns based on this evidence.
To address this need, Nova Southeastern University’s Dr. Kiran C. Patel College of Allopathic Medicine formed the South Florida Community Coalition (SFCC) for the Prevention of Opioids and Substance Abuse in At-Risk Youth. The initiative is funded by the Florida Blue Foundation and serves 3,590 youth (ages 11–18 years) in the tri-county area. The SFCC is composed of five key community partners: Take Stock in Children, Big Brothers Big Sisters, Urban League, Pace Center for Girls and SunServe. The Coalition is creating awareness campaigns, carefully curated curricular content, support groups, training modules and multimedia to improve the awareness and behaviors of at-risk youth with a focus on those who identify as racial/ethnic and gender/sexual minorities. Youth-serving professionals, caregivers and families are also helped through this program.
This program will create a database of risk factors, causes and prevention strategies for drug abuse that can serve as state-wide and national resources. Another outcome will be a culturally aligned substance abuse prevention program that increases the pool of youth-serving professionals who are trained to identify key indicators of substance abuse and extend messaging to at-risk youth and their families. The program will improve access to care through referral roadmaps and culturally competent messaging for at-risk LGBTQ youth while promoting lifetime success with opioid and substance abuse avoidance. The SFCC is creating a real and impactful reduction in OUD in the youth of South Florida and can serve as a national model for opioid and substance abuse awareness and prevention.
Acknowledgements
The authors thank and acknowledge the Florida Blue Foundation for the funding that makes this work possible (Grant Number 10080). The opinions expressed reflect those of the authors and not necessarily those of the Florida Blue Foundation.
Funding Statement
The authors thank and acknowledge the Florida Blue Foundation for the funding that makes this work possible (Grant Number 10080).
Footnotes
Conflicts of Interest
The authors declare they have no conflicts of interest.
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