Opioid-related overdose mortality continues at historically high levels in the US (see https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/202205.htm). Social determinants of health are increasingly understood to contribute to this crisis (Barocas et al., 2019; Beseran et al., 2022; Blair & Siddiqi 2022). Healthy People 2030 defines social determinants of health as the “conditions in the environments where people ae born, live, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life- outcomes and risks” (see https://health.gov/healthypeople/priority-areas/social-determinants-health). Health systems and provider/practitioner responses to the overdose mortality crisis are directly and indirectly impacted by social determinants of health. For instance, since most health insurance is still provided through employment, lower-income populations are less likely to have generous insurance plans that cover extended stays in substance use treatment. In the public health insurance system, access to Medicaid (through Medicaid expansion) has been refused in some states, leaving some populations uninsured and thus unable to make use of required mental health services (Cummings et al., 2014; Grogan et al., 2016; Saloner et al., 2017). Lastly, even for those with insurance, mental health parity in coverage continues to be not fully implemented (Dickson-Gomez et al., 2022) and among existing providers reluctance to accept Medicaid reimbursement amounts has lowered patient access to medication for opioid use disorder (MOUD) (Knudsen & Studts 2019). In the following, we will identify issues at the intersection of SODH, overdose deaths, and health systems and providers for purposes of providing recommendations and examples from the field on practice-based and evidence-based efforts to address the overdose death crisis.

Interdisciplinary Association of Population Health Sciences, 2023