Recent Incarceration, Substance Use, Overdose, and Service Use Among People Who Use Drugs in Rural Communities

Abstract

ImportanceDrug 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.ObjectiveTo characterize associations between recent incarceration, overdose, and substance use disorder (SUD) treatment access among rural PWUD.Design, Setting, and ParticipantsFor 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.ExposureRecent 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 MeasuresThe associations between PWUD who were recently incarcerated and main outcomes of treatment use and overdose were examined using logistic regression.ResultsOf 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 RelevanceIn 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.

Community buprenorphine continuation post-release following extended release vs. sublingual buprenorphine during incarceration: a pilot project in Maine

“…Combined with findings from other studies of MOUD treatment at the time of jail release, our study findings highlight the need for access to OUD treatment for all incarcerated individuals with OUD. The correctional setting can provide an important opportunity to engage individuals in treatment due to the strong associations between SUD and criminal justice involvement (Hoover et al, 2023 ; Winkelman et al, 2018 ). In addition to providing MOUD during incarceration—including XRB, other policy changes are needed to increase access to care and improve care transitions upon release to the community.…”

“…In addition to providing MOUD during incarceration—including XRB, other policy changes are needed to increase access to care and improve care transitions upon release to the community. A recent analysis of survey results from the Rural Opioid Initiative found that individuals who had been recently incarcerated were more likely to report having difficulty accessing MOUD than those without a history of recent incarceration (Hoover et al, 2023 ). The study also found that recent incarceration was associated with lower rates of health insurance coverage, which could contribute to gaps in post-release treatment and medication adherence during a transition period in which individuals may experience high levels of stress and uncertainty (Hoover et al, 2023 ).…”

“…Even if states are granted 1115 Demonstration waivers allowing pre-release Medicaid coverage, the high upfront cost of XRB during incarceration may continue to be a barrier. One solution could involve eliminating the Medicaid exclusion for incarcerated individuals altogether, a change that would also encourage consistency in SUD treatment within correctional facilities nationally (Hoover et al, 2023 ).…”

Error in Grant Number

“…In the Original Investigation titled “Recent Incarceration, Substance Use, Overdose, and Service Use Among People Who Use Drugs in Rural Communities,” 1 published November 9, 2023, there was a typographic error in a grant number in the Funding/Support paragraph. The grant number now reads, “UG3DA044822/UH3DA044822.” This article has been corrected.…”