Motivation to Change and Treatment Participation Among Syringe Service Program Utilizers in Rural Kentucky

Abstract

Purpose Kentucky experiences a disproportionate burden of substance use disorder (SUD), particularly in rural areas of the state. Multiple factors increase vulnerability to SUD and limit access to services in rural communities. However, the recent implementation and expansion of syringe service programs (SSPs) in rural Kentucky may provide a leverage point to reach at‐risk people who inject drugs (PWID). Methods Data were collected as part of an ongoing NIDA‐funded study designed to examine uptake of SSPs among PWID in Appalachian Kentucky. Using Respondent Driven Sampling (RDS), the study enrolled a sample of 186 PWID SSP attenders across 3 rural Appalachian Kentucky counties and conducted face‐to‐face interviews regarding health behaviors, injecting practices, SSP utilization, and treatment services. Using logistic regression analyses, we examined consistent SSP use, as well as importance and confidence to reduce substance use as predictors of current treatment participation. Findings For the prior 6 months, 44.6% of the sample reported consistent SSP use. Consistent use of SSPs was associated with treatment participation in the unadjusted logistic regression models. Significant predictors of treatment participation in the adjusted model included high confidence to reduce substance use, and not reporting primary methamphetamine injection. Conclusions Rurally located SSPs may play an important role in supporting confidence and motivation to change substance use behaviors among PWID impacted by SUD. SSPs may be critical venues for integration and expansion of prevention, health promotion, and treatment linkage services for this underserved population.

Community Meetings on the Rural Opioid Crisis: Setting a Path Forward by Learning from Others

“…37 Additionally, researchers found that about half of their sample of 186 syringe service program attendees in rural Kentucky regularly utilize such services. 38 This finding signals a possible demand in rural areas for syringe exchange programs. Future studies may want to include a wider variety of options than the ones considered here.…”

Characteristics Associated with Motivation to Stop Substance use and Improve Skin and Needle Hygiene among Hospitalized Patients who Inject Drugs

“…[10][11][12] Yet identifying additional modifiable characteristics that can be leveraged to enhance motivation is especially relevant for improving clinical outcomes for PWID. 6,35 In this analysis, we found that more severe opioid withdrawal was associated with decreased motivation to use clean needles. Withdrawal is a complex neurobiological phenomenon that may dampen motivation and shift an individual's attention to relieving uncomfortable symptoms.…”

“…[2][3][4] Motivation is an important step in changing substance use patterns and in engaging in treatment. 5,6 Several studies including PWID suggest that medical hospitalizations are associated with heightened motivation to seek substance use treatment. 7,8 Internal (e.g., concerns about one's own health) and external factors (e.g., family concerns) have been associated with increased motivation for substance use treatment.…”

A qualitative analysis of rural syringe service program fidelity in Appalachian Kentucky: Staff and participant perspectives

“…21 For example, limited public transportation availability in geographically remote rural areas, a feature of the physical environment, may restrict the accessibility of SSP services; and high drug-related stigma in small, tight-knit rural communities, a feature of the social environment, may increase PWID reluctance to enroll in local SSPs. 14,15,[22][23][24][25] This analysis assesses the extent to which 5 of the…”

“…Rural is defined as scoring a 7 or higher on the RUCC and having at least 2/3 of the population residing in a rural area as reported by the US Census Bureau 21 . For example, limited public transportation availability in geographically remote rural areas, a feature of the physical environment, may restrict the accessibility of SSP services; and high drug‐related stigma in small, tight‐knit rural communities, a feature of the social environment, may increase PWID reluctance to enroll in local SSPs 14,15,22–25 …”