Understanding rural risk environments for drug-related harms: Progress, challenges, and steps forward

Ibragimov, Umedjon; Young, April M.; Cooper, Hannah L.F.

doi:10.1016/j.drugpo.2020.102926

Cited by 14 publications

(10 citation statements)

References 31 publications

(46 reference statements)

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“…SSPs also help to reduce the impact of structural stigma by issuing program IDs to protect their clients from police searches, syringe confiscation and arrest. These findings on the role of programs and social networks in reducing stigma and promoting access to services contribute to the growing acknowledgement of meso-level in REF literature, [ 59 ] showing how these factors absorb the impact of negative forces such as stigma acting at other levels of environment.…”

Section: Discussionmentioning

confidence: 88%

Factors that influence enrollment in syringe services programs in rural areas: a qualitative study among program clients in Appalachian Kentucky

et al. 2021

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Background Enrolling sufficient number of people who inject drugs (PWID) into syringe services programs (SSP) is important to curtail outbreaks of drug-related harms. Still, little is known about barriers and facilitators to SSP enrollment in rural areas with no history of such programs. This study’s purpose was to develop a grounded theory of the role of the risk environment and individual characteristics of PWID in shaping SSP enrollment in rural Kentucky. Methods We conducted one-on-one semi-structured interviews with 41 clients of 5 SSPs that were established in rural counties in Appalachian Kentucky in 2017–2018. Interviews covered PWID needs, the process of becoming aware of SSPs, and barriers and facilitators to SSP enrollment. Applying constructivist grounded theory methods and guided by the Intersectional Risk Environment Framework (IREF), we applied open, axial and selective coding to develop the grounded theory. Results Stigma, a feature of IREF’s meso-level social domain, is the main factor hampering SSP enrollment. PWID hesitated to visit SSPs because of internalized stigma and because of anticipated stigma from police, friends, family and healthcare providers. Fear of stigma was often mitigated or amplified by a constellation of meso-level environmental factors related to healthcare (e.g., SSPs) and social (PWID networks) domains and by PWID’s individual characteristics. SSPs mitigated stigma as a barrier to enrollment by providing low threshold services in a friendly atmosphere, and by offering their clients program IDs to protect them from paraphernalia charges. SSP clients spread positive information about the program within PWID networks and helped their hesitant peers to enroll by accompanying them to SSPs. Individual characteristics, including child custody, employment or high social status, made certain PWID more susceptible to drug-related stigma and hence more likely to delay SSP enrollment. Conclusions Features of the social and healthcare environments operating at the meso-level, as well as PWID’s individual characteristics, appear to enhance or mitigate the effect of stigma as a barrier to SSP enrollment. SSPs opening in locations with high stigma against PWID need to ensure low threshold and friendly services, protect their clients from police and mobilize PWID networks to promote enrollment.

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Section: Discussionmentioning

confidence: 88%

Factors that influence enrollment in syringe services programs in rural areas: a qualitative study among program clients in Appalachian Kentucky

et al. 2021

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“…Future trainings should acknowledge the historical underpinnings of these openly expressed stigmatizing attitudes, including widespread concerns about the recent crisis in over-prescription of pharmaceutical opioids against which MOUD advocates must constantly work to set themselves apart from. Trainings could also include information about the ceiling effect of buprenorphine and other pharmacotherapy characteristics that may assuage fears of repeating an cascade of pharmaceutical overprescribing—an issue that may be particularly salient in rural areas (Compton, Jones, & Baldwin, 2016; Ibragimov, Young, & Cooper, 2020; Rigg, Monnat, & Chavez, 2018; G. A. Victor, Walker, Cole, & Logan, 2017; Volkow & McLellan, 2016).…”

Section: Discussionmentioning

confidence: 99%

Medications for Opioid Use Disorder in the Criminal/Legal System: Knowledge, Beliefs, and Attitudes Among Rural Community-Based Stakeholders

Victor

Lee

Pozo

et al. 2022

Journal of Drug Issues

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The aim of this study was to describe rural community stakeholders’ attitudes and perceptions of providing medication for opioid use disorder (MOUD) to individuals in the criminal/legal system. Data were utilized from a technical assistance initiative aimed at strengthening community-based OUD treatment within criminal/legal systems. A mixed-methods approach was applied. Survey responses were used to compare stakeholders’ who had and had not attended an MOUD training, and semistructured interviews were conducted with a convenience sample of rural criminal/legal and treatment stakeholders. MOUD training was associated with endorsing the effectiveness of methadone, oral naltrexone, and injectable naltrexone. Three primary themes emerged from the stakeholder interviews: 1) acceptance of MOUD uptake; 2) stigma of MOUD and diversion concerns; and 3) gaps in MOUD treatment. Most interviewees noted that there is a scarcity of treatment options in their community, and among the existing services, there are considerable barriers to care.

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“…They observed a number of areas where harms were shaped by these factors, including in relation to NSP access and the management of risk by users, in addition to factors such as employment-related IPED use in the regional economy. With recent literature using the risk environment framework to examine illicit drug harms more broadly in the context of rural communities (Fadanelli et al, 2020; Ibragimov et al, 2020; Jenkins & Hagan, 2020; Kolak et al, 2020), a synthesis of Hanley Santos and Coomber’s (2017) risk environment approach to IPEDs with key developments from the rural drug harms literature may therefore help facilitate greater understanding of the factors influencing harm among rural IPED users.…”

Section: Rurality and The Rural “Risk Environment”mentioning

confidence: 99%

Exploring the Impacts of Rurality on Service Access and Harm Among Image and Performance Enhancing Drug (IPED) Users in a Remote English Region

Turnock

Mulrooney

2023

Contemporary Drug Problems

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Image and performance enhancing drugs (IPEDs) have been highlighted in recent years as posing a potential risk to public health, with much research dedicated to exploring the use of these drugs and associated harms. While recent work has considered harm reduction for IPED users, the geographic and cultural impacts of rurality on IPED use and harms, particularly in relation to harm reduction service access, remains comparatively under-explored. Features of rurality relating to levels of economic distress, the inheritance and decline of manual labor, and rural conceptions of masculinity are important in shaping drug harms. Consequently, the “rural risk environment” for IPED users is in need of exploration. This research examines the experiences of IPED users in a remote two-county region of rural England, drawn from a multi-year ethnography and 18 qualitative interviews with IPED users, to explore the impacts of rurality and the “rural risk environment” on service access and harm (reduction) within this population. Findings highlight a number of ways in which rurality impacted on IPED users’ access to harm reduction services such as needle and syringe programs (NSP), as well as engagement with healthcare practitioners (HCP). Issues included the distances required to access services and lack of public transport between towns; the impacts of stigma in a small town context where there is little anonymity; Distrust of HCP relating to cultural mindsets and regionally derived fears regarding impacts on employment prospects, particularly military; and the impacts of rural masculinities and perceptions of the self-sufficient “real man” on help-seeking when experiencing harm. The research highlights the need to incorporate cultural geographic understandings into harm reduction policy for IPED users, and the significance of rurality on experiences of harm.

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Understanding rural risk environments for drug-related harms: Progress, challenges, and steps forward

Cited by 14 publications

References 31 publications

Factors that influence enrollment in syringe services programs in rural areas: a qualitative study among program clients in Appalachian Kentucky

Factors that influence enrollment in syringe services programs in rural areas: a qualitative study among program clients in Appalachian Kentucky

Medications for Opioid Use Disorder in the Criminal/Legal System: Knowledge, Beliefs, and Attitudes Among Rural Community-Based Stakeholders

Exploring the Impacts of Rurality on Service Access and Harm Among Image and Performance Enhancing Drug (IPED) Users in a Remote English Region

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