Andrea Acevedo, PhD, and Shikhar Shrestha, PhD are co-chairs of the Substance Use Disorder and Mental Health (SUD/MH) subgroup of the Equity Research Cluster. In this profile, we ask Drs. Acevedo and Shrestha how they came to their interest in SUD/MH and about this research area’s relationship to equity.

Dr. Acevedo, Assistant Professor in the Community Health Department, has over 15 years of experience working in health services research. Much of her work has assessed inequities related to the treatment of substance use disorders, focusing specifically on racial and ethnic differences. Dr. Acevedo believes that emphasizing equity when studying SUDs is essential. In her research, she has found that communities of color often experience worse social consequences from SUDs. Policies that are “race-neutral” often maintain or worsen health inequities. Dr. Acevedo reports that “having an equity focus allows us to assess, understand drivers of, and inform the development of new policies and programs to improve the lives of people with a substance use disorder and reduce these inequities.”

Although an equity-based approach to research is crucial for reducing health disparities among marginalized communities, conducting research on treatment inequities can be difficult at times. In Dr. Acevedo’s health services research, she utilizes administrative data and medical claims. Frequently, she encounters poor quality data. Sometimes there is incomplete data on individual’s race/ethnicity or on certain social determinants of health often associated with inequities.  Without fully understanding these factors, policy makers find it far more difficult to create interventions that best address health conditions, such as substance use disorders.  

Dr. Shrestha is Assistant Professor in the Department of Public Health and Community Medicine at the Tufts University School of Medicine. His research focuses on the opioid crisis, which, he notes, offers vivid examples of health inequities. Until the last few years, the opioid epidemic has mainly afflicted non-Hispanic white communities. This produced a mild societal response—one that centers on medical and social approach to solving opioid use disorders. Dr. Shrestha cites that this “was in stark contrast to how the crack cocaine epidemic, which primarily affected racial and ethnic minorities, was handled.” Now, as the opioid crisis has spread among historically marginalized groups, research must study methods to provide these populations equitable access to healthcare and opioid use disorder related services.

Dr. Shrestha’s new study, “Syndromic Surveillance of the Opioid Crisis in Lowell, Massachusetts,” will evaluate the communication network among people who use drugs in the community, and assess how they get information, treatment, and harm reduction services. A surveillance component aims to halve the time it takes to warn the community of opioid-related overdose outbreaks. The goal is to reduce the risk of overdose through active collaboration with peer networks, as well as treatment and harm reduction programs.

For both Drs. Acevedo and Shrestha, assessing inequities in the prevalence and treatment of substance use disorders is important by itself but also informs the overall aims of the Equity Research Cluster. Dr. Acevedo and Dr. Shrestha also agree that the issues SUD/MH researchers work on are often personal and felt close to home, impacting family members, friends, and others we love.

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