Polysubstance use in rural West Virginia: Associations between latent classes of drug use, overdose, and take-home naloxone

Schneider, Kristin E.; O’Rourke, Allison; White, Rebecca Hamilton; Park, Ju Nyeong; Musci, Raschelle J.; Kilkenny, Michael E.; Sherman, Susan G.; Allen, Sean T.

doi:10.1016/j.drugpo.2019.102642

Cited by 37 publications

(17 citation statements)

References 45 publications

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“…Although these behaviors often occur in tandem, few have employed latent class analysis (LCA) to examine the complex patterns of polysubstance use among women who exchange sex [ 27 , 34 , 35 , 36 ]. LCA has been used to understand patterns of polysubstance use of both injection and non-injection drugs among various populations, including adolescents [ 37 ], adults in urban and rural settings [ 38 , 39 , 40 , 41 , 42 , 43 ], and women living with HIV [ 26 ]. Classes of people who engage in polysubstance use have been shown to have a differential risk of poor health and Hepatitis C virus (HCV) [ 41 , 42 ].…”

Section: Introductionmentioning

confidence: 99%

Latent Classes of Polysubstance Use and Associations with HIV Risk and Structural Vulnerabilities among Cisgender Women Who Engage in Street-Based Transactional Sex in Baltimore City

Beckham

Glick

Schneider

et al. 2022

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We describe patterns of polysubstance use and associations with HIV risk-related behaviors among women engaged in street-based transactional sex, an understudied yet important population and area of research. This sample was restricted to cisgender women who reported drug use (n = 244) in the baseline of the longitudinal SAPPHIRE cohort study. Latent class analysis (LCA) was conducted using drug use measures (route of administration (injection/non-injection); type of drug (specific opioids, stimulants)) and selection based on fit statistics and qualitative interpretation of the classes. Polysubstance use was prevalent (89% ≥2), and 68% had injected drugs in the past 3 months. A three-class solution was selected: Class 1 (“heroin/cocaine use”, 48.4% of sample), Class 2 (“poly-opioid use”, 21.3%), and Class 3 (“poly-route, polysubstance use”, 30.3%). Class 3 was significantly younger, and Class 2 was disproportionately non-White. Women reported high levels of housing (63%) and food (55%) insecurity, condomless sex with clients (40%), and client-perpetrated violence (35%), with no significant differences by class. Obtaining syringes from syringe services programs differed significantly by class, despite injection behaviors in all classes. Tailored HIV and overdose prevention programming that considers drug use patterns would strengthen their impact.

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Section: Introductionmentioning

confidence: 99%

Latent Classes of Polysubstance Use and Associations with HIV Risk and Structural Vulnerabilities among Cisgender Women Who Engage in Street-Based Transactional Sex in Baltimore City

Beckham

Glick

Schneider

et al. 2022

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“…Studies have also shown that patterns of substance use differ between urban and rural areas, with rural people being more likely than their urban counterparts to inject drugs and engage in polysubstance use. [13–15]. IDU‐associated consequences can be prevented through the implementation of syringe services programs (SSPs), which provide a myriad of services to PWID, such as access to sterile injection equipment and drug treatment referrals [1].…”

Section: Introductionmentioning

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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“…New guidelines governing naloxone distribution were issued by the West Virginia state legislature in 2015, which maintained naloxone as a prescription medication and mandated stringent reporting requirements not placed on other controlled substances [ 21 ]. A latent class analysis using data from 2018 found that polysubstance use among people who inject drugs in Cabell County was highly prevalent and was associated with both overdose and receiving take-home naloxone [ 22 ]. Needle and syringe programs (NSP) have expanded in Appalachia since 2013, with nine open in West Virginia in August of 2017, although access is limited in many counties [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

Hostility, compassion and role reversal in West Virginia’s long opioid overdose emergency

et al. 2020

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Background West Virginia is a largely rural state with strong ties of kinship, mutual systems of support and charitable giving. At the same time, wealth inequalities are extreme and the state’s drug overdose fatality rate stands above all others in the USA at 51.5/100,000 in 2018, largely opioid-related. In recent years, harm reduction services have been active in the state but in 2018 Charleston’s needle and syringe program was forced to close. This paper considers the risk environment in which the state’s drug-related loss of life, and those attempting to prevent it, exist. Methods This rapid ethnographic study involved semi-structured interviews (n = 21), observation and video recordings of injection sequences (n = 5), initially recruiting people who inject heroin/fentanyl (PWIH) at the Charleston needle and syringe program. Snowball sampling led the research team to surrounding towns in southern West Virginia. Telephone interviews (n = 2) with individuals involved in service provision were also carried out. Results PWIH in southern West Virginia described an often unsupportive, at times hostile risk environment that may increase the risk of overdose fatalities. Negative experiences, including from some emergency responders, and fears of punitive legal consequences from calling these services may deter PWIH from seeking essential help. Compassion fatigue and burnout may play a part in this, along with resentment regarding high demands placed by the overdose crisis on impoverished state resources. We also found low levels of knowledge about safe injection practices among PWIH. Conclusions Hostility faced by PWIH may increase their risk of overdose fatalities, injection-related injury and the risk of HIV and hepatitis C transmission by deterring help-seeking and limiting the range of harm reduction services provided locally. Greater provision of overdose prevention education and naloxone for peer distribution could help PWIH to reverse overdoses while alleviating the burden on emergency services. Although essential for reducing mortality, measures that address drug use alone are not enough to safeguard longer-term public health. The new wave of psychostimulant-related deaths underline the urgency of addressing the deeper causes that feed high-risk patterns of drug use beyond drugs and drug use.

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Polysubstance use in rural West Virginia: Associations between latent classes of drug use, overdose, and take-home naloxone

Cited by 37 publications

References 45 publications

Latent Classes of Polysubstance Use and Associations with HIV Risk and Structural Vulnerabilities among Cisgender Women Who Engage in Street-Based Transactional Sex in Baltimore City

Latent Classes of Polysubstance Use and Associations with HIV Risk and Structural Vulnerabilities among Cisgender Women Who Engage in Street-Based Transactional Sex in Baltimore City

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

Hostility, compassion and role reversal in West Virginia’s long opioid overdose emergency

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