Abstract
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.
Original language | English |
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Pages (from-to) | E2342222 |
Journal | JAMA network open |
Volume | 6 |
Issue number | 11 |
DOIs | |
State | Published - Nov 9 2023 |
Bibliographical note
Publisher Copyright:© 2023 American Medical Association. All rights reserved.
Funding
In this cross-sectional survey of 2935 PWUD in rural communities, 42% were recently incarcerated. Recent incarceration was associated with past-6-month overdose, substance use treatment, and not accessing treatment in the past 6 months but not treatment with MOUD or currently carrying naloxone. Research presented in this article is the result of secondary data harmonization and analysis, and was supported by grant U24DA048538 from NIDA. Primary data collection was supported by grants UG3DA044829/UH3DA044829, UG3DA044798/UH3DA044798, UG3DA044830/UH3DA044830, UG3DA044823/UH3DA044823, UH3DA044822/UH3DA044822, UG3DA044831/UH3DA044831, UG3DA044825, UG3DA044826/UH3DA044826, U24DA044801, and UL1TR002369 cofunded by NIDA, the Appalachian Regional Commission, the Centers for Disease Control and Prevention, and the Substance Abuse and Mental Health Services Administration.
Funders | Funder number |
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National Institute on Drug Abuse | UG3DA044829/UH3DA044829, UL1TR002369, UH3DA044822/UH3DA044822, UG3DA044798/UH3DA044798, UG3DA044826/UH3DA044826, UG3DA044823/UH3DA044823, UG3DA044831/UH3DA044831, UG3DA044830/UH3DA044830, UG3DA044825, U24DA044801 |
National Institute on Drug Abuse | |
Centers for Disease Control and Prevention | |
Substance Abuse and Mental Health Services Administration | |
Appalachian Regional Commission |
ASJC Scopus subject areas
- General Medicine