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- Title
Recent Incarceration, Substance Use, Overdose, and Service Use Among People Who Use Drugs in Rural Communities.
- Authors
Hoover, Daniel B.; Korthuis, P. Todd; Waddell, Elizabeth Needham; Foot, Canyon; Conway, Caitlin; Crane, Heidi M.; Friedmann, Peter D.; Go, Vivian F.; Nance, Robin M.; Pho, Mai T.; Satcher, Milan F.; Sibley, Adams; Westergaard, Ryan P.; Young, April M.; Cook, Ryan
- Abstract
This cross-sectional study analyzes data from the Rural Opioid Initiative research consortium survey to assess associations between recent incarceration, overdose, and substance use disorder treatment access among rural people who use drugs. Key Points: Question: How do substance use treatment access, use of medication for opioid use disorder (MOUD), and overdose in rural areas differ for recently incarcerated people who use drugs (PWUD), compared with PWUD who have not been recently incarcerated? Findings: In this cross-sectional survey of 2935 PWUD in rural communities, 42% were recently incarcerated. Recent incarceration was associated with past-6-month overdose, substance use treatment, and not accessing treatment in the past 6 months but not treatment with MOUD or currently carrying naloxone. Meaning: The results of this study suggest that MOUD may be underused following incarceration in rural areas, despite clear evidence of benefit and support from multiple national organizations, and that the rural criminal legal system, especially jails and prisons, must urgently implement MOUD services. Importance: Drug use and incarceration have a substantial impact on rural communities, but factors associated with the incarceration of rural people who use drugs (PWUD) have not been thoroughly investigated. Objective: To characterize associations between recent incarceration, overdose, and substance use disorder (SUD) treatment access among rural PWUD. Design, Setting, and Participants: For this cross-sectional study, the Rural Opioid Initiative research consortium conducted a survey in geographically diverse rural counties with high rates of overdose across 10 US states (Illinois, Wisconsin, North Carolina, Oregon, Kentucky, West Virginia, Ohio, Massachusetts, New Hampshire, and Vermont) between January 25, 2018, and March 17, 2020, asking PWUD about their substance use, substance use treatment, and interactions with the criminal legal system. Participants were recruited through respondent-driven sampling in 8 rural US regions. Respondents who were willing to recruit additional respondents from their personal networks were enrolled at syringe service programs, community support organizations, and through direct community outreach; these so-called seed respondents then recruited others. Of 3044 respondents, 2935 included participants who resided in rural communities and reported past-30-day injection of any drug or use of opioids nonmedically via any route. Data were analyzed from February 8, 2022, to September 15, 2023. Exposure: Recent incarceration was the exposure of interest, defined as a report of incarceration in jail or prison for at least 1 day in the past 6 months. Main Outcomes and Measures: The associations between PWUD who were recently incarcerated and main outcomes of treatment use and overdose were examined using logistic regression. Results: Of 2935 participants, 1662 (56.6%) were male, 2496 (85.0%) were White; the mean (SD) age was 36 (10) years; and in the past 30 days, 2507 (85.4%) reported opioid use and 1663 (56.7%) reported injecting drugs daily. A total of 1224 participants (41.7%) reported recent incarceration, with a median (IQR) incarceration of 15 (3-60) days in the past 6 months. Recent incarceration was associated with past-6-month overdose (adjusted odds ratio [AOR], 1.38; 95% CI, 1.12-1.70) and recent SUD treatment (AOR, 1.62; 95% CI, 1.36-1.93) but not recent medication for opioid use disorder (MOUD; AOR, 1.03; 95% CI, 0.82-1.28) or currently carrying naloxone (AOR, 1.02; 95% CI, 0.86-1.21). Conclusions and Relevance: In this cross-sectional study of PWUD in rural areas, participants commonly experienced recent incarceration, which was not associated with MOUD, an effective and lifesaving treatment. The criminal legal system should implement effective SUD treatment in rural areas, including MOUD and provision of naloxone, to fully align with evidence-based SUD health care policies.
- Subjects
UNITED States; SUBSTANCE abuse; CONFIDENCE intervals; PRISONERS; RURAL conditions; CROSS-sectional method; NALOXONE; DESCRIPTIVE statistics; CHI-squared test; RESEARCH funding; LOGISTIC regression analysis; ODDS ratio; DRUG abusers
- Publication
JAMA Network Open, 2023, Vol 6, Issue 11, pe2342222
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.42222