Risk Environment of the Ohio Opiate Market

Introduction: Risk environment frameworks, an off shoot of the ecological frameworks, examine the socio-political environment and the role that oppression through structural and environmental factors can have on individual risk taking behavior (Blakenship, Bray & Merson, 2000; Farmer et al., 2006; Krieger, 2001, Rhodes, 2002; Rhodes et al., 2005; Rhodes, 2009; Rhodes et al., 2012 ). Understanding the risk environment provides practitioners with an understanding of the best approaches to implement harm reduction within communities (Rhodes, 2002; Rhodes et al., 2005; Rhodes, 2009; Small, 2007; Rhodes et al., 2012). Although engaging in risky substance use behaviors, including the injection of heroin, are often examined on the individual level, it is imperative to fully explore the lived experience of the individual in their environment.

Methods: This paper is a theoretical application of the risk environment framework to the Ohio opiate epidemic. The theory is grounded in an Ohio specific context using qualitative data from a secondary data analysis of the 2000 to 2016 Ohio Substance Abuse Monitoring System. This mixed methods study is conducted every six months in the Toledo, Cleveland, Youngstown, Columbus, Cincinnati, Dayton, Akron-Canton, and Athens region of Ohio. Regional epidemiologists gather information on availability, price, purity, and methods of use from consumers. Data triangulation is achieved through survey administration and semi-structured interviews with substance use treatment providers and law enforcement.

Results: Risks in the physical environment include locations to access substances, saturation in communities, proximity to others states without regulations, and community structure. Social risks include the criminalization of behavior, services delivery options, stigma, and limited advocacy on behalf of substance users. Economic risks center around limited access to employment related to the recession, costs associated with living and health, and informal economies. Political risks involve access to harm reduction in communities, drug court options, and pain management and prescribing guidelines. Although each of these risk environments are capable of harm to communities in their own right, the intersection of these risk environments merged to negatively impact the opiate addicted population in Ohio, with a particular impact on rural communities.

Conclusions: Understanding the risk environment for opiate use within Ohio is important to create effective prevention and interventions within communities. When the risk environments are considered, the cumulative impact of structural inequality on health outcomes is apparent. A risk environment framework can be used to inform targeted prevention approaches to address substance abuse.