Substance use in rural Central Appalachia: Current status and treatment considerations.

Moody, Lara; Satterwhite, Emily; Bickel, Warren K.

doi:10.1037/rmh0000064

Cited by 134 publications

(122 citation statements)

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“…The Appalachian states of Kentucky, Ohio, and West Virginia rank among the top five states for age-adjusted opioid overdose deaths [ 10 ]. The region also suffers disproportionate rates of opioid related HIV and HCV transmission [ 5 , 11 ] as use of opioids exceeds national averages [ 9 , 11 , 12 ]. Despite the heavy use of opioids, the economic deprivation specific to Appalachia (i.e., low formal education, high rates of unemployment related to the economy) [ 11 , 13 ] creates significant challenges to accessing appropriate care.…”

Section: Introductionmentioning

confidence: 99%

Clinician identified barriers to treatment for individuals in Appalachia with opioid use disorder following release from prison: a social ecological approach

Bunting

Oser

Staton

et al. 2018

Addict Sci Clin Pract

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BackgroundThe non-medical use of opioids has reached epidemic levels nationwide, and rural areas have been particularly affected by increasing rates of overdose mortality as well as increases in the prison population. Individuals with opioid use disorder (OUD) are at increased risk for relapse and overdose upon reentry to the community due to decreased tolerance during incarceration. It is crucial to identify barriers to substance use disorder treatment post-release from prison because treatment can be particularly difficult to access in resource-limited rural Appalachia.MethodsA social ecological framework was utilized to examine barriers to community-based substance use treatment among individuals with OUD in Appalachian Kentucky following release from prison. Semi-structured qualitative interviews with 15 social service clinicians (SSCs) employed by the Department of Corrections were conducted to identify barriers at the individual, interpersonal, organizational/institutional level, community, and systems levels. Two independent coders conducted line-by-line coding to identify key themes.ResultsTreatment barriers were identified across the social ecological spectrum. At the individual-level, SSCs highlighted high-risk drug use and a lack of motivation. At the interpersonal level, homogenous social networks (i.e., homophilious drug-using networks) and networks with limited treatment knowledge inhibited treatment. SSC’s high case load and probation/parole officer’s limited understanding of treatment were organizational/institutional barriers. Easy access to opioids, few treatment resources, and a lack of community support for treatment were barriers at the community level. SSC’s noted system-level barriers such as lack of transportation options, cost, and uncertainty about the implementation of the Affordable Care Act.ConclusionsMore rural infrastructure resources as well as additional education for family networks, corrections staff, and the community at large in Appalachia are needed to address barriers to OUD treatment. Future research should examine barriers from the perspective of other key stakeholders (e.g., clients, families of clients) and test interventions to increase access to OUD treatment.

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Section: Introductionmentioning

confidence: 99%

Clinician identified barriers to treatment for individuals in Appalachia with opioid use disorder following release from prison: a social ecological approach

Bunting

Oser

Staton

et al. 2018

Addict Sci Clin Pract

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“…6 Central Appalachia's drug use trends can be attributed to various factors, including low education levels, high unemployment levels, and high rates of job-related injuries. 7 These factors can also be applicable in other regions.…”

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confidence: 99%

Centers for Disease Control and Prevention Recommendations for Hepatitis C Testing: The Need to Adopt Universal Screening in an Appalachian Emergency Department

Wojcik

Sharon

Davis

et al. 2020

Academic Emergency Medicine

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Background The Centers for Disease Control and Prevention recommends screening baby boomers and high‐risk patients for hepatitis C virus (HCV); however, the incidence of HCV is rapidly increasing among younger populations, and screening is limited by access to care and risk factor assessment. The purpose of this study was to evaluate characteristics of HCV antibody‐positive (Ab+) and ribonucleic acid (RNA)‐confirmed‐positive patients identified via two screening models in an Appalachian emergency department (ED). Methods This was a retrospective cohort study of patients who screened HCV Ab+ in the ED from January 1 to October 31, 2018. Data were extracted, and comparative analyses were conducted between the risk‐based and the universal screening models. Results Overall, 444 patients screened HCV Ab+, with a median age of 39 years. From January to May 2018, the risk factor model identified 126 HCV Ab+ patients out of 3,014 screened (4%), whereas from June to October 2018, the universal model identified 318 HCV Ab+ patients out of 5,407 screened (6%; p < 0.001). A consistently large proportion of diagnoses were new (71%). There was no statistically significant decrease between the RNA‐confirmed‐positive patients during the risk factor model (76, 60%) and universal model (186, 58%) time periods (p = 0.72). The models had high rates of reported intravenous drug use, and the universal screening adoption was modest at 33%. Conclusion This study was the first to present characteristics of HCV Ab+ and RNA‐confirmed‐positive patients identified during the transition to a universal screening model in an Appalachian ED. Most diagnoses were new regardless of screening model, but more patients screened HCV Ab+, and a similar proportion were RNA‐confirmed‐positive, under the universal model. Given that adoption of universal screening was modest, and risk factors remained similar, future research should investigate how to more effectively implement a universal screening model on a wider scale to identify early infections.

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“…Still, there was no consideration about age in this study, so subsequent studies can be guided to examine the various effect of unemployment rate by age groups. Third, the subsisting pattern of high correlation between unemployment and mental and substanceuse mortality in the rural Appalachia can be attributed to the marginalized living condition and distressed economic hardship (Shamblin, Williams, and Bellaw 2012;Moody, Satterwhite, and Bickel 2017) and professional to monitor and take care of ongoing or potential patients (Hendryx 2008). Even though we controlled the typical factors that affect mortality, the high positive residuals in such regions indicate there would be unexplained and intermediating factors that will improve the model ( Figure S12).…”

Section: Discussionmentioning

confidence: 99%

County-level association of unemployment to mortality in the coterminous United States: a Bayesian spatiotemporal modeling approach

Song¹

2020

Preprint

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This study spatiotemporally examines an association between unemployment and mortality. Hypothesizing the spatiotemporally heterogeneous association, we employ the Integrated Nested Laplace Approximation (INLA)-based random slope model with the spatiotemporal interaction under the control of common covariates. The model design aims to investigate the spatiotemporally transforming relationship between unemployment rates and mortality rates. The causes for all, self-harm, and mental disorders in 3,108 coterminous counties in the United States for 2001-2014, which includes two economic recessions, are considered. The results show the sporadic spatial effect and the cause-specific change of spatiotemporal interactions during the study period. The spatiotemporal patterns did not only have the same magnitude but also show the same direction of shift for causes of death. The spatiotemporal changes of the associations of one-year lagged unemployment rates are summarized as follows: (1) Dakotas and the west Appalachian counties have highly positive association in recent years; (2) the geographical shifts in high association regions were various for each cause of death: the dividing cluster for all-cause, the southerly moving cluster for the self-harm and interpersonal violence, and intensifying clusters in central and west Appalachian for the mental and substance-use disorders mortality; (3) the associations become weaker during the Great Recession period. Those patterns may be attributed to regional contexts, such as devoid of healthcare facilities and psychological deprivation. Even though there are possible mediating factors indicated by the substantial degree of residuals in some regions, our approach illustrates that the association of unemployment and mortality is spatiotemporally different across regions. It also suggests the spatiotemporal approach is effective in investigating the relationship between unemployment and mortality.

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Substance use in rural Central Appalachia: Current status and treatment considerations.

Cited by 134 publications

References 50 publications

Clinician identified barriers to treatment for individuals in Appalachia with opioid use disorder following release from prison: a social ecological approach

Clinician identified barriers to treatment for individuals in Appalachia with opioid use disorder following release from prison: a social ecological approach

Centers for Disease Control and Prevention Recommendations for Hepatitis C Testing: The Need to Adopt Universal Screening in an Appalachian Emergency Department

County-level association of unemployment to mortality in the coterminous United States: a Bayesian spatiotemporal modeling approach

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