TY - JOUR
AU - D. B. Hoover
AU - P. T. Korthuis
AU - E. N. Waddell
AU - C. Foot
AU - C. Conway
AU - H. M. Crane
AU - P. D. Friedmann
AU - V. F. Go
AU - R. M. Nance
AU - M. T. Pho
AU - M. F. Satcher
AU - A. Sibley
AU - R. P. Westergaard
AU - A. M. Young
AU - R. Cook
A1 - 
AB - 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.
AD - Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland.; Oregon Health & Science University-Portland State University School of Public Health, Portland.; Division of General Internal Medicine, Oregon Health & Science University, Portland.; University of Wisconsin Madison, Madison.; Department of Medicine, University of Washington, Seattle.; Office of Research, University of Massachusetts Chan Medical School-Baystate, Baystate Health, Springfield.; Department of Health Behavior, University of North Carolina-Chapel Hill, Chapel Hill.; Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago, Chicago, Illinois.; Department of Community & Family Medicine, Dartmouth Health and Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire.; Department of Medicine, University of Wisconsin-Madison, Madison.; College of Public Health, University of Kentucky, Lexington.
AN - 37943559
BT - JAMA Netw Open
C5 - Opioids & Substance Use; Healthcare Disparities
CP - 11
DA - Nov 1
DO - 10.1001/jamanetworkopen.2023.42222
DP - NLM
ET - 20231101
IS - 11
JF - JAMA Netw Open
LA - eng
N2 - 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.
PY - 2023
SN - 2574-3805
SP - e2342222
ST - Recent Incarceration, Substance Use, Overdose, and Service Use Among People Who Use Drugs in Rural Communities
T1 - Recent Incarceration, Substance Use, Overdose, and Service Use Among People Who Use Drugs in Rural Communities
T2 - JAMA Netw Open
TI - Recent Incarceration, Substance Use, Overdose, and Service Use Among People Who Use Drugs in Rural Communities
U1 - Opioids & Substance Use; Healthcare Disparities
U3 - 10.1001/jamanetworkopen.2023.42222
VL - 6
VO - 2574-3805
Y1 - 2023
ER -