What is a rural opioid risk and policy environment?

HIV-Related Stigma Research as a Priority at the National Institutes of Health

“…Stigma in human service settings and self-stigma among PWUD can lead to insufficient access to substance use disorder treatment and harm reduction, as well as insufficient access to screening and care for co-occurring disorders such mental illness and HIV [ 140 ]. Providers also may avoid serving PLWH and drug users because they are concerned that it will stigmatize their practice [ 141 ]. The persistence of drug use-related stigmas has implications for the ability of the EHE initiative and other public health efforts to provide effective outreach and engagement in ways and at levels needed to reach their goals.…”

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

“…CBPR is a proven method to help ensure meaningful inclusion of marginalized and hard-to-reach populations, including PWUD, in the design, implementation, interpretation and dissemination of research (Christopher, Watts, McCormick, & Young, 2008;Coughlin, 2016). While no studies in our special issue employed this method, empirical findings and theoretical discussions of high social cohesion of rural PWUD networks and their embeddedness in larger communities (Jenkins & Hagan, 2019;Showalter, 2020;Thomas et al, 2019) suggest that CBPR may be a useful strategy for studying rural risk environments in the future.…”

“…Approaches Jenkins and Hagan (2019) observed that variations in risk environments can arise across urban, suburban, and rural risk environments that are all governed by the same state or province's policies, and Kolak et al (2020) documented multiple risk environment typologies within ZIP codes and counties in a single rural region of one US state. As Cooper and colleagues (2020) note, REM and other multilevel conceptual models have historically been dominated by structuralist approaches that assume that features of the macrolevel exert monolithic impacts (Duff, 2007;Rhodes, 2009); these approaches thus leave little possibility for the heterogeneities that Jenkins and Hagan and Kolak et al consider. The emergence of post-structuralist approaches within REM, however, can actively support its deeper engagement with these heterogeneities.…”

“…The papers published in this special issue, for example, suggest that access to drug-related health services may depend on policies regulating the provision of MOUD (Richard et al, 2020); DEA and wholesaler stipulations for pharmacies dispensing opioid analgesics (Cooper et al, 2020); healthcare providers' reluctance to prescribe MOUD because of fears of medication diversion and abuse and community stigma (Cooper et al, 2020;Richard et al, 2020); the organization of service provision at pharmacies (Green et al, 2019); and geographic remoteness and lack of transportation (Csak, Szecsi, Kassai, Marvanykovi, & Racz, 2020). As observed by Jenkins and Hagan (2019), the nature of these intersecting features in rural areas may be distinct from those operating in urban areas. For instance, rural remoteness and low population density may suppress revenue for healthcare services (a feature of REM's economic domain) and may, therefore, curtail the number of healthcare providers who can prescribe MOUD (a feature of REM's healthcare domain).…”

“…Social networks illustrate this complexity. Thomas and colleagues (2019), Jenkins and Hagan (2019), and Showalter (2020) highlight that tight-knit social networks in rural communities can undermine programming by limiting anonymity and heightening fears of stigma. However, these same networks, if leveraged, can be a source of social support, foster dissemination of evidencebased practices, and facilitate progressive policy change.…”