Degree

Doctor of Philosophy (PhD)

Department

The School of Social Work

Document Type

Dissertation

Abstract

Purpose: Despite declining opioid prescription rates, Louisiana's opioid mortality rate more than tripled from 2016 to 2023, indicating that prescribing policies have not translated into reduced mortality. This study examined the distribution of opioid mortality and community characteristics associated with spatial clustering across periods of policy change and the COVID-19 pandemic.

Methods: Using the American Community Survey 5-Year Estimates and the Louisiana Opioid Data Surveillance System, I conducted a repeated cross-sectional analysis of opioid deaths (n=6,425) in Louisiana across four policy eras (2016–17, 2018–19, 2020–21, 2022–23). I identified clusters of opioid mortality at the parish and ZIP Code Tabulation Area (ZCTA) levels using Local Indicators of Spatial Association analysis. Then, using multinomial logistic regression, I examined how community-level characteristics (rurality, poverty, unemployment, educational attainment, racial composition, and opioid prescription rate) were associated with ZCTA-level concentration of opioid mortality.

Findings: The cumulative two-year mortality rate in Louisiana rose from 15.78 to 52.35 per 100,000 residents. Simultaneously, prescription rates declined. Contrary to expectations, metropolitan ZCTAs consistently exhibited the highest mean mortality rates and the greatest concentration of spatial clustering, particularly during the COVID-19 transition. Rurality was negatively associated with hotspot classification in three of four periods (OR=0.54–0.75, p< .01). The racial composition of decedents shifted substantially, with Black residents rising from 16.3% to 27.1% of deaths; by 2022–23, although communities with higher non-Hispanic White proportions were more likely to be classified as hotspots (OR=1.03, p=.006). Lastly, the granularity of the unit of analysis, ZCTA-level compared to parish, consistently provided more detail.

Significance: Opioid prescribing policies reduced prescriptions but not mortality, as illicit opioids replaced prescription opioids as the primary cause of death. Urban geography, not rurality, characterized Louisiana's opioid mortality clustering. ZCTA-level analysis provided additional detail of spatial burden missed at the parish-level, underscoring the need for granular spatial surveillance to guide resource allocation and harm-reduction investment in social work practice and policy.

Date

7-17-2026

Committee Chair

Jennifer Scott

LSU Acknowledgement

1

LSU Accessibility Acknowledgment

1

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Available for download on Saturday, July 31, 2027

Included in

Social Work Commons

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