Introduction to the Special Issue on the Impacts of Systemic Racism and Structural Oppression on Overdose and Substance Use Inequities.

Abstract

This special issue of the Journal of Psychoactive Drugs, titled "Confronting the Impacts of Systemic Racism and Structural Oppression on Overdose and Substance Use Inequities," addresses the disproportionate burden of drug overdose and substance use impacts borne by Black, Indigenous, and People of Color (BIPOC) communities. While overall overdose mortality rates have fluctuated, deep racial inequities persist and are driven in part by structural oppressive forces, systemic and structural racism, and White supremacy. To move beyond traditional risk-factor epidemiology and reductive "gap gazing," this collection highlights critical empirical approaches that directly measure and confront systemic harms while advancing equitable solutions. The issue features two central themes. The first theme, Measuring the Impact of Structural and/or Systemic Factors, highlights rigorous quantitative and qualitative studies that operationalize intersectional stress, racial trauma, and lifespan violence among minoritized populations. The second theme, Culturally Responsive Substance Use/Overdose Prevention, focuses on community-informed adaptations to overdose education and therapeutic settings to combat stigma and mitigate racial microaggressions. Ultimately, this issue demonstrates how critical scientific frameworks can transform substance use scholarship. By centering in the margins, evaluating evolving therapeutic interventions through an equity lens, and demanding methodological precision in documenting structural harms, this issue offers a path forward toward health justice and accountability for all people who use substances.