Estimating the Number of People Who Inject Drugs in A Rural County in Appalachia

Allen, Sean T.; O’Rourke, Allison; White, Rebecca Hamilton; Schneider, Kristin E.; Kilkenny, Michael E.; Sherman, Susan G.

doi:10.2105/ajph.2018.304873

Cited by 46 publications

(26 citation statements)

References 19 publications

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“…Data are from a capture–recapture study (June–July 2018) that estimated the number of PWID in Cabell County, WV. Detailed descriptions of the methodology employed during the parent study can be found elsewhere, and we provide an overview [36]. The capture phase took place at the Cabell‐Huntington Harm Reduction Program (CHHRP) located at the Cabell‐Huntington Health Department and provides PWID access to sterile injection equipment, overdose prevention resources, vaccinations and drug treatment referrals.…”

Section: Methodsmentioning

confidence: 99%

Prevalence and correlates of receptive syringe‐sharing among people who inject drugs in rural Appalachia

et al. 2020

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Background and Aims Syringe‐sharing significantly increases the risk of HIV and viral hepatitis acquisition among people who inject drugs (PWID). Clearer understanding of the correlates of receptive syringe‐sharing (RSS) is a critical step in preventing bloodborne infectious disease transmission among PWID in rural communities throughout the United States. This study aimed to measure the prevalence and correlates of RSS among PWID in a rural county in Appalachia. Design Observational, cross‐sectional sample from a capture–recapture parent study. Setting Cabell County, West Virginia (WV), USA, June–July 2018. Participants The sample was restricted to people who reported injecting drugs in the past 6 months (n = 420). A total of 180 participants (43%) reported recent (past 6 months) RSS. Participants reported high levels of homelessness (56.0%), food insecurity (64.8%) and unemployment (66.0%). Measurements The main outcome was recent re‐use of syringes that participants knew someone else had used before them. Key explanatory variables of interest, selected from the risk environment framework, included: unemployment, arrest and receipt of sterile syringes from a syringe services program (SSP). Logistic regression was used to determine correlates of recent RSS. Findings PWID reporting recent RSS also reported higher prevalence of homelessness, food insecurity and unemployment than their non‐RSS‐engaging counterparts. In adjusted analyses, correlates of RSS included: engagement in transactional sex work [adjusted odds ratio (aOR) = 2.27, 95% confidence interval (CI) = 1.26–4.09], unemployment (aOR = 1.67, 95% CI = 1.03–1.72), number of drug types injected (aOR = 1.33, 95% CI = 1.15–1.53) and injection in a public location (aOR = 2.59, 95% CI = 1.64–4.08). Having accessed sterile syringes at an SSP was protective against RSS (aOR = 0.57, 95% CI = 0.35–0.92). Conclusion The prevalence of receptive syringe‐sharing among people who inject drugs in a rural US county appears to be high and comparable to urban‐based populations. Receptive syringe‐sharing among people who inject drugs in a rural setting appears to be associated with several structural and substance use factors, including unemployment and engaging in public injection drug use. Having recently acquired sterile syringes at a syringe services program appears to be protective against receptive syringe sharing.

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Section: Methodsmentioning

confidence: 99%

Prevalence and correlates of receptive syringe‐sharing among people who inject drugs in rural Appalachia

et al. 2020

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“…This research is part of a larger study that aimed to estimate the number of PWID in Cabell County, WV; detailed methods describing data collection in the parent study can be found in related publications [35–37]. For brevity, we provide an overview.…”

Section: Methodsmentioning

confidence: 99%

Acceptability of safe drug consumption spaces among people who inject drugs in rural West Virginia

et al. 2019

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Aim Safe consumption spaces (SCS) are indoor environments in which people can use drugs with trained personnel on site to provide overdose reversal and risk reduction services. SCS have been shown to reduce fatal overdoses, decrease public syringe disposal, and reduce public drug consumption. Existing SCS research in the USA has explored acceptability for the hypothetical use of SCS, but primarily among urban populations of people who inject drugs (PWID). Given the disproportionate impact of the opioid crisis in rural communities, this research examines hypothetical SCS acceptability among a rural sample of PWID in West Virginia. Methods Data were drawn from a 2018 cross-sectional survey of PWID ( n = 373) who reported injection drug use in the previous 6 months and residence in Cabell County, West Virginia. Participants were asked about their hypothetical use of a SCS with responses dichotomized into two groups, likely and unlikely SCS users. Chi-square and t tests were conducted to identify differences between likely and unlikely SCS users across demographic, substance use, and health measures. Results Survey participants were 59.5% male, 83.4% non-Hispanic White, and 79.1% reported likely hypothetical SCS use. Hypothetical SCS users were significantly ( p < .05) more likely to have recently (past 6 months) injected cocaine (38.3% vs. 25.7%), speedball (41.0% vs. 24.3%), and to report preferring drugs containing fentanyl (32.5% vs. 20.3%). Additionally, likely SCS users were significantly more likely to have recently experienced an overdose (46.8% vs. 32.4%), witnessed an overdose (78.3% vs. 60.8%), and received naloxone (51.2% vs. 37.8%). Likely SCS users were less likely to have borrowed a syringe from a friend (34.6% vs. 48.7%). Conclusions Rural PWID engaging in high-risk behaviors perceive SCS as an acceptable harm reduction strategy. SCS may be a viable option to reduce overdose fatalities in rural communities.

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“…Rural communities throughout the USA need evidence-based interventions to reduce the consequences of the opioid epidemic (e.g., HIV and viral hepatitis outbreaks, overdose fatalities) among people who inject drugs (PWID) [1–4]. Syringe services programs (SSPs) are effective structural interventions that have demonstrated public health benefits [5–13].…”

Section: Introductionmentioning

confidence: 99%

Understanding the public health consequences of suspending a rural syringe services program: a qualitative study of the experiences of people who inject drugs

Allen

Grieb²,

O’Rourke

et al. 2019

Harm Reduct J

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Background Syringe services programs (SSPs) are evidence-based interventions that are associated with decreases in prevalence and incidence rates of HIV and viral hepatitis among people who inject drugs (PWID). SSPs are also effective conduits to deliver overdose prevention resources among PWID. In December 2015, the Kanawha-Charleston Health Department (KCHD) in West Virginia implemented a SSP; however, the program was indefinitely suspended in early 2018 following policy changes that would have forced the program to operate in ways that conflicted with established best practices. The purpose of this research is to explore the public health implications of the suspension of the KCHD SSP among rural PWID. Methods We conducted semi-structured interviews with 27 PWID (59.3% male, 88.9% White) to explore access to sterile injection equipment and overdose prevention resources, high-risk injection practices, and HIV risk perceptions following the KCHD SSP suspension. Participants were recruited from street locations frequented by PWID. Interviews were audio-recorded and transcribed verbatim . We employed an iterative, modified constant comparison approach to systematically code and synthesize textual interview data. Results Participants described the KCHD SSP as providing a variety of harm reduction services to PWID and being able to speak honestly with SSP staff about their drug use without fear of stigmatization. The suspension of the KCHD SSP fundamentally changed the public health landscape for PWID, ushering in a new era of increased risks for acquiring bloodborne infections and overdose. PWID described more frequently injecting with used syringes and engaging in a range of high-risk injection practices after the SSP was suspended. PWID also discussed having decreased access to naloxone and being less likely to get routinely tested for HIV following the KCHD SSP suspension. Conclusions This research demonstrates that the suspension of a SSP in rural West Virginia increased risks for HIV/HCV acquisition and overdose among PWID. The suspension of the SSP led to community-wide decreases in access to sterile injection equipment and naloxone among PWID. The suspension of the KCHD SSP should be viewed as a call to action for sustaining evidence-based interventions in the face of sociopolitical forces that attempt to subvert public health.

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Estimating the Number of People Who Inject Drugs in A Rural County in Appalachia

Cited by 46 publications

References 19 publications

Prevalence and correlates of receptive syringe‐sharing among people who inject drugs in rural Appalachia

Prevalence and correlates of receptive syringe‐sharing among people who inject drugs in rural Appalachia

Acceptability of safe drug consumption spaces among people who inject drugs in rural West Virginia

Understanding the public health consequences of suspending a rural syringe services program: a qualitative study of the experiences of people who inject drugs

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