Exploring racial differences in opioid overdose terminology preferences for rural patients: Presenter(s): Delesha Carpenter, University of North Carolina at Chapel Hill, United States

In the United States, overdose deaths disproportionately affect rural populations, with the overdose death rate of Black people now exceeding that of non-Hispanic White people. Little is known about rural patients’ preferences for discussing overdose at the pharmacy, where naloxone (an overdose reversal medication) can be dispensed without a prescription. Our objective is to compare rural Black and non-Hispanic White people’s preferences for discussing overdose with pharmacists. A convenience sample of 40 rural patients who were at high risk of opioid overdose from four states completed a digitally recorded 30-45 minute semi-structured interview. Patients were asked which term (“overdose,” “accidental overdose,” or “bad reaction”) they preferred for their pharmacist to use when discussing overdose risk. Using MAXQDA, two coders independently read each interview transcript, used a study codebook to code passages, and met to reach consensus on coding. Subsequent analysis focused on comparing Black and White patients’ communication preferences. Eight (20%) patients were Black. Seven (88%) Black and 14 (44%) White patients preferred the term “bad reaction” because it was perceived as less stigmatizing than the other terms. Patients who disliked “bad reaction” thought it was either too vague or did not capture the severity of an overdose. One patient stated, “I think a ‘bad reaction’ isn’t nearly severe enough where it grabs your attention.” Thirteen White (41%) patients and one Black (12%) patient preferred the term “accidental overdose” because they thought it was less stigmatizing than “overdose” and more medically accurate than “bad reaction.” Overall, rural patients preferred that pharmacists use the term “bad reaction” when discussing overdose risk, but a stronger preference for the term “bad reaction” was found among Black patients. Rural pharmacists should consider using the term “bad reaction” when discussing overdose risk with patients, particularly Black patients.