Zoned Out of School: Intersectionality of Race and Gender on Adolescent Opioid Use

• In Event: Drawing on Experience-Near Knowledge: Understanding School (Dis)Engagement Through Youth and Educator Voice

Abstract

Substance use among high school students interferes with school engagement and persistence. Despite efforts to limit access and decrease illicit use of prescription drugs (Monitoring the Future, 2018), the opioid crisis continues to affect adolescents, Assumptions regarding the characteristics of youth most likely to use drugs may exacerbate barriers to care, with greater risk of overdose for girls compared to boys. Using chart reviews, in-depth qualitative interviews, and brief clinical measures we (1) examined substance abuse and referral patterns for adolescents in residential detox treatment, and (2) how a subset of the sample described experiences related to substance use in daily life and in school.

Methods: Participants were recruited from a detoxification and stabilization unit serving dual-diagnosed adolescents, ages 13 to 18 with a substance-related disorder; average stay of 14 days. Charts from 422 patients were reviewed (30% girls, 70% boys; 78% White, 13% Latino, 8% African American; Table 1). A subset of 40 youth (17 girls, 23 boys) completed a qualitative interview and the Teen Addiction Severity Index (T-ASI; Kaminer, et al., 1991) to investigate meaning and motives of the interviewee's attitudes, behavior, and perceptions related to substance abuse history. Chi-square and regression were used to evaluate prevalence and predictors of opiate dependence by race and gender; thematic analysis was used to understand race by gender patterns in adolescent opioid use.

Results: 10.7% of Latinos reported using heroin compared to 26.3% of White peers; 14.3% of Latinos admitted to use of other opiates versus 38.7% of White adolescents. Similar patterns held for African American adolescents compared to White youth. Girls presented with significantly higher rates of opioid use compared to boys. Girls were more likely to be diagnosed with depression, anxiety, and PTSD; boys were more likely to be diagnosed with ADHD. Adversity histories revealed higher rates of abuse for girls, and more adversities overall. Examining race/ and gender together, white girls were primarily in detox for misuse of prescription drugs, while Black and Latino boys had lower prevalence rates across all substances with the exception of alcohol use. T-ASI results showed substance use was a “considerable problem” for the school domain.

Qualitative interview themes included (1) Context of Romantic Relationships: girls described substance use in the context of relationships with male peers; (2) Self-Medication: girls used drugs when alone in response to distress; (3) Double Standards by Gender: boys described use with male peers, and negative attitudes about girls’ use; (4) Double Standards by Race: White boys described the ease of using and selling drugs without fear of surveillance; and (5) Social Value of School: school as place for social substance use outweighing its educational value.

Conclusions: Latino and Black adolescents in this study had a lower prevalence of opiate use, but similar school disengagement as White peers. Girls may require a higher level of opiate dependence to receive care for addiction, suggesting a gender-based disparity in services use. The intersection of racial differences and gender risk factors for adolescent opioid use has implications for school-based services development.

Authors

• Michelle V. Porche, University of California - San Francisco

• Lisa Fortuna, Boston Medical Center