People, places, and stigma: A qualitative study exploring the overdose risk environment in rural Kentucky

Fadanelli, Monica; Cloud, David H.; Ibragimov, Umedjon; Ballard, April M; Prood, Nadya; Young, April M.; Cooper, Hannah L.F.

doi:10.1016/j.drugpo.2019.11.001

Cited by 36 publications

(36 citation statements)

References 63 publications

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“…Those living in a small urban/rural centre had almost 2.5 times the odds of smoking opioids when compared to those living in larger centres. This could be due to the lower availability and acceptability of needle distribution programs in these areas, where people who use drugs are more likely to be recognized and ostracized [ 28 , 29 ]. In addition, stigma against people who use drugs is pervasive in rural settings [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Examining prevalence and correlates of smoking opioids in British Columbia: opioids are more often smoked than injected

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Papamihali

Graham

et al. 2021

Subst Abuse Treat Prev Policy

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Background British Columbia (BC) is in the midst of an opioid overdose crisis. Since 2017, smoking illicit drugs has been the leading mode of drug administration causing overdose death. Yet, little is known about people who smoke opioids, and factors underlying choice of mode of administration. The study objectives are to identify the prevalence and correlates associated with smoking opioids. Methods The Harm Reduction Client Survey is a monitoring tool used by the BC Centre for Disease Control since 2012. This survey is disseminated to harm reduction sites across BC to understand drug use trends and drug-related harms. We examined data from the survey administered October–December 2019 and performed descriptive, univariate, and multivariate analyses to better understand factors associated with smoking opioids. Results A total of 369 people who used opioids in the past 3 days were included, of whom 251 (68.0%) reported smoking opioids. A total of 109 (29.5%) respondents experienced an overdose in the past 6 months; of these 79 (72.5%) smoked opioids. Factors significantly associated with smoking opioids were: living in a small community (AOR =2.41, CI =1.27–4.58), being a woman (AOR = 1.84, CI = 1.03–3.30), age under 30 (AOR = 5.41, CI = 2.19–13.40) or 30–39 (AOR = 2.77, CI = 1.33–5.78) compared to age ≥ 50, using drugs alone (AOR = 2.98, CI = 1.30–6.83), and owning a take-home naloxone kit (AOR = 2.01, CI = 1.08–3.72). Reported use of methamphetamines within the past 3 days was strongly associated with smoking opioids (AOR = 6.48, CI = 3.51–11.96). Conclusions Our findings highlight important correlates associated with smoking opioids, particularly the recent use of methamphetamines. These findings identify actions to better respond to the overdose crisis, such as targeted harm reduction approaches, educating on safer smoking, advocating for consumption sites where people can smoke drugs, and providing a regulated supply of opioids that can be smoked.

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Section: Discussionmentioning

confidence: 99%

Examining prevalence and correlates of smoking opioids in British Columbia: opioids are more often smoked than injected

Parent

Papamihali

Graham

et al. 2021

Subst Abuse Treat Prev Policy

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“…Stigma is an important barrier to services in rural Appalachia: PWID living in this region report that anticipated stigma is a reason to avoid attending SSPs or obtaining and carrying clean syringes [ 10 , 20 , 26 ]. Public stigma against PWID and related local opposition to harm reduction hampered access to drug-related services in the region, including preventing new SSPs from opening or closure of existing ones [ 21 , 24 , 25 , 29 – 33 ].…”

Section: Introductionmentioning

confidence: 99%

“…The study’s purpose was to develop a grounded theory of the role of the risk environment and individual characteristics in SSP enrollment among PWID. Since IDU-related stigma is prevalent in rural Kentucky, [ 10 , 24 , 29 ] we were especially interested in studying factors that may amplify or mitigate the role of stigma as a barrier to enrollment. The study findings may inform planning and implementation of SSP in rural areas.…”

Section: Introductionmentioning

confidence: 99%

“…REF posits that drug-related risk behaviors, including service utilization, are the function of influence and interaction of external forces mapped by REF into environment domains (physical, social, policy, economical, law enforcement and healthcare) and levels (macro-, micro-, and, in some literature, meso-level). REF posits that stigma is a feature of macro-level social environment, rooted in negative stereotypes, norms and beliefs prevailing in rural communities, and intertwined with policy and law enforcement (“War on Drugs”) environments [ 29 ]. IREF extends REF by conceptualizing an intersecting social location of an individual (a set of individual characteristics, such as age, gender, race, defined by the systems of oppression or privilege) as a mechanism mediating and modifying the impact of risk environment on individual health outcomes [ 35 ].…”

Section: Introductionmentioning

confidence: 99%

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Factors that influence enrollment in syringe services programs in rural areas: a qualitative study among program clients in Appalachian Kentucky

et al. 2021

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Background Enrolling sufficient number of people who inject drugs (PWID) into syringe services programs (SSP) is important to curtail outbreaks of drug-related harms. Still, little is known about barriers and facilitators to SSP enrollment in rural areas with no history of such programs. This study’s purpose was to develop a grounded theory of the role of the risk environment and individual characteristics of PWID in shaping SSP enrollment in rural Kentucky. Methods We conducted one-on-one semi-structured interviews with 41 clients of 5 SSPs that were established in rural counties in Appalachian Kentucky in 2017–2018. Interviews covered PWID needs, the process of becoming aware of SSPs, and barriers and facilitators to SSP enrollment. Applying constructivist grounded theory methods and guided by the Intersectional Risk Environment Framework (IREF), we applied open, axial and selective coding to develop the grounded theory. Results Stigma, a feature of IREF’s meso-level social domain, is the main factor hampering SSP enrollment. PWID hesitated to visit SSPs because of internalized stigma and because of anticipated stigma from police, friends, family and healthcare providers. Fear of stigma was often mitigated or amplified by a constellation of meso-level environmental factors related to healthcare (e.g., SSPs) and social (PWID networks) domains and by PWID’s individual characteristics. SSPs mitigated stigma as a barrier to enrollment by providing low threshold services in a friendly atmosphere, and by offering their clients program IDs to protect them from paraphernalia charges. SSP clients spread positive information about the program within PWID networks and helped their hesitant peers to enroll by accompanying them to SSPs. Individual characteristics, including child custody, employment or high social status, made certain PWID more susceptible to drug-related stigma and hence more likely to delay SSP enrollment. Conclusions Features of the social and healthcare environments operating at the meso-level, as well as PWID’s individual characteristics, appear to enhance or mitigate the effect of stigma as a barrier to SSP enrollment. SSPs opening in locations with high stigma against PWID need to ensure low threshold and friendly services, protect their clients from police and mobilize PWID networks to promote enrollment.

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“…Secondly, it is reasonable to assume that pre‐existing social–structural factors will continue to compromise the effectiveness of interventions, regardless of any innovation. While fentanyl‐related deaths in North America are elevated in socio‐economically disadvantaged regions [9] and urban areas with large homeless and street‐injecting scenes [10], substantial increases have recently occurred among demographics with traditionally lower levels of opioid use, including women [11] and those from rural communities [12]. Regardless of location, these are populations disproportionately impacted by social, political and economic systems of disadvantage (e.g .…”

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confidence: 99%

Addressing fentanyl‐related harms: maximizing the efficiency of innovative interventions

2020

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People, places, and stigma: A qualitative study exploring the overdose risk environment in rural Kentucky

Cited by 36 publications

References 63 publications

Examining prevalence and correlates of smoking opioids in British Columbia: opioids are more often smoked than injected

Examining prevalence and correlates of smoking opioids in British Columbia: opioids are more often smoked than injected

Factors that influence enrollment in syringe services programs in rural areas: a qualitative study among program clients in Appalachian Kentucky

Addressing fentanyl‐related harms: maximizing the efficiency of innovative interventions

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