Attitudes toward syringe exchange programs in a rural Appalachian community

Zeller, T Aaron; Beachler, Taylor; Diaz, Liam; Thomas, Richard P.; Heo, Moonseong; Lanzillotta-Rangeley, Jennifer; Litwin, Alain H.

doi:10.1080/10550887.2021.1979837

Cited by 8 publications

(5 citation statements)

References 34 publications

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“…We also found that bystanders held misconceptions about naloxone, echoing previous research [72,73], and that these misconceptions inhibited naloxone uptake. Specifically, some bystanders believed naloxone encourages riskier drug use and/or discourages recovery.…”

Section: Discussionsupporting

confidence: 87%

“…While beliefs about naloxone causing higher risk drug use are widespread, they are largely unfounded; research indicates that acquisition of naloxone by PWUIO does not increase high risk behaviors [80] and may actually decrease high risk drug use behaviors [81]. Such misconceptions may significantly influence support for naloxone; in contrast, better understanding of OUD is associated with greater support and acceptance of harm reduction programs, including naloxone distribution [72], indicating that interventions that increase compassionate awareness of OUD may positively impact naloxone uptake.…”

Section: Discussionmentioning

confidence: 99%

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If We Build It, Will They Come? Perspectives on Pharmacy-Based Naloxone Among Family and Friends of People who use Opioids: A Mixed Methods Study

Slocum

Ozga

Walley

et al. 2021

Preprint

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Background: Expanding access to the opioid antagonist naloxone to reduce overdose mortality is a public health priority in the United States. Naloxone standing orders (NSOs) have been established in many states to increase naloxone dispensing at pharmacies, but increased pharmacy access does not ensure optimal uptake among those likely to witness an overdose. In a prior statewide purchase trial, we documented high levels of naloxone access at Massachusetts pharmacies under a statewide NSO. In this study, we characterize barriers to pharmacy-based naloxone uptake among potential opioid overdose “bystanders” (friends or family of people who use opioids) that may be amenable to intervention.Methods: Eligible bystanders were Massachusetts residents >18 years of age, did not use illicit opioids in the past 30 days, and knew someone who currently uses illicit opioids. We used a sequential mixed methods approach, in which a series of semi-structured qualitative interviews (N=22) were conducted to inform the development of a subsequent quantitative survey (N=260). Results: Most survey participants (77%) reported ever obtaining naloxone but few (21%) attempted to purchase it at a pharmacy. Qualitative participants revealed that barriers to utilizing the NSO included low perceived risk of overdose, which was rooted in misconceptions regarding the risks of prescription opioid misuse, denial about their loved one’s drug use, and drug use stereotypes; inaccurate beliefs about the impact of naloxone on riskier opioid use; and concerns regarding anticipated stigma and confidentiality. Many participants had engaged in mutual support groups, which served as a source of free naloxone for half (50%) of those who had ever obtained naloxone.Conclusions: Despite high levels of pharmacy naloxone access in Massachusetts, few bystanders in our study had attempted to obtain naloxone under the NSO. Low perceived risk of overdose, misinformation, stigma and confidentiality were important barriers to pharmacy naloxone uptake, all of which are amenable to intervention. Support groups provided a setting for addressing stigma and misinformation and provided a discreet and comfortable setting for naloxone access. Where these groups do not exist and for bystanders who do not participate in such groups, pharmacies are well-positioned to fill gaps in naloxone availability.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

If We Build It, Will They Come? Perspectives on Pharmacy-Based Naloxone Among Family and Friends of People who use Opioids: A Mixed Methods Study

Slocum

Ozga

Walley

et al. 2021

Preprint

View full text Add to dashboard Cite

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“…Although respondents are neutral for supporting the concept of SSP and SCSs, they appear to disagree somewhat strongly on locations and utilizations of SSP, financial support for SSP, and MOUD treatment for incarcerated population. The factors associated with support for SSP found in a sub-analysis of the 2019 OCORT data [ 34 ] were mostly replicated in the present analysis. While respondents perhaps understand the need for harm reduction resources such as SSPs or SCSs, they might also be somewhat resistant to building or placing physical resources to that end.…”

Section: Discussionsupporting

confidence: 74%

Harm reduction and recovery services support (HRRSS) to mitigate the opioid overdose epidemic in a rural community

Heo

Beachler

Sivaraj

et al. 2023

Subst Abuse Treat Prev Policy

Self Cite

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Background Rural areas in the United States (US) are ravaged by the opioid overdose epidemic. Oconee County, an entirely rural county in northwest South Carolina, is likewise severely affected. Lack of harm reduction and recovery resources (e.g., social capital) that could mitigate the worst outcomes may be exacerbating the problem. We aimed to identify demographic and other factors associated with support for harm reduction and recovery services in the community. Methods The Oconee County Opioid Response Taskforce conducted a 46-item survey targeting a general population between May and June in 2022, which was mainly distributed through social media networks. The survey included demographic factors and assessed attitudes and beliefs toward individuals with opioid use disorder (OUD) and medications for OUD, and support for harm reduction and recovery services, such as syringe services programs and safe consumption sites. We developed a Harm Reduction and Recovery Support Score (HRRSS), a composite score of nine items ranging from 0 to 9 to measure level of support for placement of naloxone in public places and harm reduction and recovery service sites. Primary statistical analysis using general linear regression models tested significance of differences in HRRSS between groups defined by item responses adjusting for demographic factors. Results There were 338 survey responses: 67.5% were females, 52.1% were 55 years old or older, 87.3% were Whites, 83.1% were non-Hispanic, 53.0% were employed, and 53.8% had household income greater than US$50,000. The overall HRRSS was relatively low at a mean of 4.1 (SD = 2.3). Younger and employed respondents had significantly greater HRRSS. Among nine significant factors associated with HRRSS after adjusting for demographic factors, agreement that OUD is a disease had the greatest adjusted mean difference in HRSSS (adjusted diff = 1.22, 95% CI=(0.64, 1.80), p < 0.001), followed by effectiveness of medications for OUD (adjusted diff = 1.11, 95%CI=(0.50, 1.71), p < 0.001). Conclusions Low HRRSS indicates low levels of acceptance of harm reduction potentially impacting both intangible and tangible social capital as it relates to mitigation of the opioid overdose epidemic. Increasing community awareness of the disease model of OUD and the effectiveness of medications for OUD, especially among older and unemployed populations, could be a step toward improving community uptake of the harm reduction and recovery service resources critical to individual recovery efforts.

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“…For example, research has shown that there is an inverse relationship between food security and syringe sharing among PWID [43]. Notably, we found that experiencing weekly hunger was associated with greater Rural communities may also be characterized by substantial sociopolitical barriers that obstruct the implementation of low-threshold and evidence-based response strategies for mitigating the consequences of injection drug use [7,[36][37][38]. Additionally, rural PWID may reside in locations distal to HIV testing sites and experience transportation barriers.…”

Section: Discussionmentioning

confidence: 73%

Factors Associated with HIV Testing Among People Who Inject Drugs: Findings from a Multistate Study at the Start of the COVID-19 Pandemic

et al. 2022

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stigmatization of substance use may also deter help-seeking behaviors among PWID [8][9][10].Throughout the world, the COVID-19 pandemic affected every aspect of public health, including the delivery of HIV prevention services [11][12][13][14]. For example, lockdowns and social distancing practices increased risk for IDU-associated HIV transmission due to reductions in SSP utilization, sterile syringe coverage, and HIV testing [14][15][16][17][18]. Many SSPs were also short-staffed during the COVID-19 pandemic and experienced delays in funding and loss of funding opportunities [19]. A study conducted among PWID in New York (US) during COVID-19 also found higher levels of mental health issues, syringe reuse, and alcohol consumption, as well as reduced buprenorphine utilization, as compared to PWID sampled before the pandemic [15]. Recent analyses similarly found that the COVID-19 pandemic disrupted an increasing trend in preexposure prophylaxis (PrEP) prescriptions for HIV prevention in the US [20].Given that nearly 40% of new HIV infections are transmitted by persons unaware of their infection, routine HIV testing is vital to ensuring the public health of vulnerable populations [21].

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Attitudes toward syringe exchange programs in a rural Appalachian community

Cited by 8 publications

References 34 publications

If We Build It, Will They Come? Perspectives on Pharmacy-Based Naloxone Among Family and Friends of People who use Opioids: A Mixed Methods Study

If We Build It, Will They Come? Perspectives on Pharmacy-Based Naloxone Among Family and Friends of People who use Opioids: A Mixed Methods Study

Harm reduction and recovery services support (HRRSS) to mitigate the opioid overdose epidemic in a rural community

Factors Associated with HIV Testing Among People Who Inject Drugs: Findings from a Multistate Study at the Start of the COVID-19 Pandemic

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