Social determinants of health can be understood as “the broad range of personal, social, economic, and environmental factors that determine individual and population health.”31 At a population level, this can be understood as the quantity and quality of resources a society makes available to all of its members, which include, but are not limited to: conditions of childhood; access to income; education and literacy; food, housing, and employment; working conditions; and health and social services.31,32 Distribution of these resources tends to occur along a social gradient,33 and is shaped by factors such as socioeconomic class and income; sex, gender identity, and sexuality; Indigeneity; race and ethnicity; citizenship status; geographic location (e.g., urban vs. rural or remote); and disability status.32,34 These factors are often interrelated and intersectional—meaning that people occupy multiple social positions by nature of their unique identity, and that these factors interact with and impact each other.35 People who belong to marginalized groups and/or occupy the lowest socioeconomic classes experience the most significant barriers to accessing resources, and, in turn, have the poorest health outcomes.34

Opioid use and OUD should be viewed within this larger social context. Higher prevalence rates of substance use and substance use disorders are observed among individuals who report adverse early childhood experiences,36 lower socioeconomic status, identify as a racial or ethnic minority, or identify as sexual or gender minorities.37,38 

Clinicians, care teams, and staff should have an understanding of how the unequal distribution of power, opportunity, and resources in Canadian society impacts the social determinants of health for individuals.34 Clinicians providing care to individuals, groups, and those communities at risk of discrimination and marginalization should endeavour to identify and remove barriers to accessing care. EQUIP Health Care provides several resources as well as a Health Equity Toolkit to support health care providers to implement equity-oriented care into primary health care practice. Additionally, clinicians should aim to address inequities that may exist related to the social determinants of health by connecting patients with resources to meet their social and survival needs (e.g., housing, food/nutrition, financial assistance, employment).