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The Compounding Effect of Intersectionality on People who use Drugs

June 17, 2024

by Jessica Irvin

Overview

Intersectionality is defined as “the framework for understanding how various aspects of individual identity…interact to create unique experiences of privilege or oppression.” People who use drugs are often part of multiple minority groups, compounding the effect of their identities on their experiences and increasing the likelihood that they will experience oppression in systems.

Aspects of music like beats, melodies, harmonies, and words are layered to create a song. Similarly, an individual’s identity is composed of many layers, including their sex, race, sexual orientation, cultural identity, disability, and life experiences. These layers of identity influence our interactions with social systems and those around us and can result in an individual having more or fewer negative experiences and outcomes than others. This is at the core of the concept of intersectionality.

Intersectionality is defined as “the framework for understanding how various aspects of individual identity – including race, gender, social class, and sexuality – interact to create unique experiences of privilege or oppression.” (Britannica, 2024).  People who use drugs are often part of multiple minority groups, compounding the effect of their identities on their experiences and increasing the likelihood that they will experience oppression in systems.  

For example, people of color in the US are more likely to be incarcerated than white people. The National Institute of Drug Abuse reports that approximately 65 percent of individuals experiencing incarceration meet criteria for a substance use diagnosis and are over ten times more likely to die of overdose within the first two weeks after release from incarceration. Since people with intersectional identities that include substance use are incarcerated at higher rates, they are subsequently more likely to die of post-release overdose.

Knowing that law is a social determinant of health, how do legislatures enact laws that consider intersectionality to prevent overdose death instead of exacerbating it? 

  1. Ask the question: Use a framework, like the Racial Equity Impact Assessment Toolkit, to ask who is or will be disproportionately impacted by a policy.
  2. Include voices of individuals with lived and current experience: Proactively reach out to people with intersectional identities — including experience with drug use — to provide insight into the policy; better yet, invite them to be on your policy team. Keep in mind that one voice of lived experience is not representative of all voices.
  3. Act in response to evidence, not out of fear: It can be tempting for policymakers to continue criminalizing the use of some drugs, as they have for the last 50 plus years. However, this approach disproportionately impacts individuals that experience intersectionality. Policymakers should instead:
    • Expand equitable access to medications for opioid use disorder (NIDA, 2023). Research demonstrates that people of color experience additional barriers when accessing substance use disorder treatment (Bui, 2022). Organizational policy and state law should elevate equal access to treatment for everyone.  
    • Fully fund harm reduction programs and the distribution of sterile use supplies. Access to sterile use supplies is correlated with positive health outcomes including the reduction of transmission of blood borne pathogens, access to healthcare services, and overdose prevention (CDC, 2023).
    • Repeal drug paraphernalia laws. These laws cause harm to people who use drugs, their families, and their communities through the continued criminalization of sterile use supplies.  We should work to minimize negative interactions with law enforcement for individuals who experience intersectionality to reduce the risk of arrest and incarceration.

It is possible to change health outcomes for individuals who experience oppression based on their intersectional identities and experience with substance use. To do so, we must be willing to consider the way the lives of individuals who use drugs are impacted by the policies we enact.

This article was written by Jessica Irvin, M.P.H., Public Health Fellow, Network for Public Health Law Harm Reduction Legal Project.

The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document do not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.

Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not represent the views of (and should not be attributed to) RWJF.