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Lister JJ, Weaver A, Ellis JD, Himle JA, Ledgerwood DM. A systematic review of rural-specific barriers to medication treatment for opioid use disorder in the United States. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2019; 46:273-288. [PMID: 31809217 DOI: 10.1080/00952990.2019.1694536] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Opioid-related deaths have risen dramatically in rural communities. Prior studies highlight few medication treatment providers for opioid use disorder in rural communities, though literature has yet to examine rural-specific treatment barriers. OBJECTIVES We conducted a systematic review to highlight the state of knowledge around rural medication treatment for opioid use disorder, identify consumer- and provider-focused treatment barriers, and discuss rural-specific implications. METHODS We systematically reviewed the literature using PsycINFO, Web of Science, and PubMed databases (January 2018). Articles meeting inclusion criteria involved rural samples or urban/rural comparisons targeting outpatient medication treatment for opioid use disorder, and were conducted in the U.S. to minimize healthcare differences. Our analysis categorized consumer- and/or provider-focused barriers, and coded barriers as related to treatment availability, accessibility, and/or acceptability. RESULTS Eighteen articles met inclusion, 15 which addressed consumer-focused barriers, while seven articles reported provider-focused barriers. Availability barriers were most commonly reported across consumer (n = 10) and provider (n = 5) studies, and included the lack of clinics/providers, backup, and resources. Acceptability barriers, described in three consumer and five provider studies, identified negative provider attitudes about addiction treatment, and providers' perceptions of treatment as unsatisfactory for rural patients. Finally, accessibility barriers related to travel and cost were detailed in four consumer-focused studies whereas two provider-focused studies identified time constraints. CONCLUSIONS Our findings consistently identified a lack of medication providers and rural-specific implementation challenges. This review highlights a lack of rural-focused studies involving consumer participants, treatment outcomes, or barriers impacting underserved populations. There is a need for innovative treatment delivery for opioid use disorder in rural communities and interventions targeting provider attitudes.
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Affiliation(s)
- Jamey J Lister
- School of Social Work, Rutgers University , New Brunswick, NJ, USA.,School of Medicine, Department of Psychiatry and Behavioral Neurosciences, Wayne State University , Detroit, MI, USA
| | - Addie Weaver
- School of Social Work, University of Michigan , Ann Arbor, MI, USA
| | - Jennifer D Ellis
- Department of Psychology, Wayne State University , Detroit, MI, USA
| | - Joseph A Himle
- School of Social Work, University of Michigan , Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan , Ann Arbor, MI, USA
| | - David M Ledgerwood
- School of Medicine, Department of Psychiatry and Behavioral Neurosciences, Wayne State University , Detroit, MI, USA
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Couto E Cruz C, Salom CL, Dietze P, Lenton S, Burns L, Alati R. Frequent experience of discrimination among people who inject drugs: Links with health and wellbeing. Drug Alcohol Depend 2018; 190:188-194. [PMID: 30048872 DOI: 10.1016/j.drugalcdep.2018.06.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/11/2018] [Accepted: 06/11/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Previous research has shown that people who inject drugs (PWID) experience discrimination on a regular basis. This study explores the relationships between discrimination against PWID and health and wellbeing. METHODS Data on discrimination against PWID and their health and wellbeing were drawn from the Illicit Drug Reporting System collected in Australia in 2016. The Personal Wellbeing Index was used to measure wellbeing, and the Kessler-10 scale was used to measure psychological distress. Experience of overdose, injecting related illnesses, diseases, and risky injecting behaviour were also assessed. We fitted multivariate logistic regression models adjusted for socio-demographic, imprisonment history, and drug-related factors. RESULTS Of the 796 participants included in the study, the majority who reported experiencing discrimination were male (65%), heterosexual (89%), and unemployed (89%). Thirty percent of the sample (n = 238) reported they had never experienced discrimination because of their injecting drug use. Seventeen percent of participants had not experienced discrimination in the twelve months prior to the interview, 24% experienced discrimination monthly, 16% experienced discrimination weekly, and 13% experienced discrimination daily or more. Frequent discrimination was associated with increased odds of overdosing, injecting related illnesses and diseases, mental health issues, and poor wellbeing. Among those who reported experiencing discrimination, females and those who identified as Indigenous were found to have poorer health and wellbeing outcomes. CONCLUSIONS Our findings highlighted that frequent discrimination may lead to worse health and wellbeing among PWID. If our findings are supported by other research, policies aimed at reducing discrimination against PWID may be warranted or improved.
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Affiliation(s)
- Camila Couto E Cruz
- University of Queensland, Institute for Social Science Research, 80 Meiers Road, Indooroopilly, QLD 4068, Australia.
| | - Caroline L Salom
- University of Queensland, Institute for Social Science Research, 80 Meiers Road, Indooroopilly, QLD 4068, Australia.
| | - Paul Dietze
- Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia.
| | - Simon Lenton
- Curtin University, National Drug Research Institute, 10 Selby St, Shenton Park, WA 6008, Australia.
| | - Lucinda Burns
- University of New South Wales, National Drug and Alcohol Research Centre (NDARC), 22-32 King St, Randwick, NSW 2031, Australia.
| | - Rosa Alati
- University of Queensland, Institute for Social Science Research, 80 Meiers Road, Indooroopilly, QLD 4068, Australia.
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von Hippel C, Brener L, Horwitz R. Implicit and explicit internalized stigma: Relationship with risky behaviors, psychosocial functioning and healthcare access among people who inject drugs. Addict Behav 2018; 76:305-311. [PMID: 28889059 DOI: 10.1016/j.addbeh.2017.08.036] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 07/31/2017] [Accepted: 08/29/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION People who inject drugs (PWID) are stigmatized by society. Over time people may begin to internalize the stigma about their group. This research examines how implicit and explicit internalized stigma among PWID relates to health care and treatment access, psychosocial functioning, and engagement in risky behaviors. METHODS PWID were recruited from a needle and syringe program (NSP) located in Sydney, Australia. Participants completed a survey examining explicit and implicit internalized stigma, risky behaviors (e.g., sharing injecting equipment, unprotected sex), health care and treatment access (e.g., comfort attending NSPs), and psychosocial functioning (e.g., mental health). Detailed demographic variables were also collected. RESULTS A total of 115 clients completed the measures. To the degree that participants had internalized the stigma about their group (measured explicitly), they felt less comfortable attending NSPs, had greater severity of dependence, and experienced more depressive symptoms. The implicit measure of internalized stigma was related to treatment engagement and needle sharing, although the direction of these effects was unexpected. CONCLUSIONS This research highlights the importance of ongoing research into the implications of internalized stigma for PWID. Assessing both explicit and implicit internalized stigma appears to be beneficial as these are related to different health and behavioral outcomes.
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Affiliation(s)
- Courtney von Hippel
- School of Psychology, University of Queensland, St Lucia, QLD 4072, Australia.
| | - Loren Brener
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Robyn Horwitz
- School of Psychology, University of Queensland, St Lucia, QLD 4072, Australia
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Onyeka IN, Basnet S, Beynon CM, Tiihonen J, Föhr J, Kauhanen J. Association between routes of drug administration and all-cause mortality among drug users. JOURNAL OF SUBSTANCE USE 2016. [DOI: 10.3109/14659891.2015.1112847] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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From initiating injecting drug use to regular injecting: Retrospective survival analysis of injecting progression within a sample of people who inject drugs regularly. Drug Alcohol Depend 2016; 158:177-80. [PMID: 26652894 DOI: 10.1016/j.drugalcdep.2015.11.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 11/08/2015] [Accepted: 11/17/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND The initiation of injecting drug use and the commencement of a pattern of regular injecting are key milestones in injecting careers. The progression from initiation to regular injecting is a poorly understood period in these careers. METHODS Cross-sectional baseline data from a sample of people who inject drugs regularly (N=691), recorded the age at which participants initiated injecting drug use and the age they became regular (at least once per month) injectors. Survival analysis compared the rapidity of progression to regular injecting across sub-groups within the sample using bivariate log-rank testing and multivariable Cox regression. RESULTS Half of all participants progressed to regular injecting within 1 year of initiation and by the fourth year post-initiation, 91% had progressed. In bivariate analysis, there were significant differences in equality of hazards by sex (X(2)=7.75, p<0.01), from whom participants learnt to inject (X(2)=22.32, p<0.01) and the drug of injection initiation (X(2)=18.36; p<0.01). In the multivariable Cox model, only initiating injecting with heroin (HR=1.28; 95% CI: 1.09-1.50) compared with other drugs (predominantly methamphetamine) showed a significantly greater hazard, suggesting a faster progression to regular injecting. CONCLUSION This study showed that among our sample of eventual regular injectors, progression from initiation to regular injecting was rapid. By gaining a greater understanding of the dynamics of this progression, the ability to appropriately target interventions and future research is subsequently informed.
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Bluthenthal RN, Wenger L, Chu D, Quinn B, Thing J, Kral AH. Factors associated with initiating someone into illicit drug injection. Drug Alcohol Depend 2014; 144:186-92. [PMID: 25282308 PMCID: PMC4276720 DOI: 10.1016/j.drugalcdep.2014.09.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 09/05/2014] [Accepted: 09/06/2014] [Indexed: 01/28/2023]
Abstract
AIMS Most people who inject drugs (PWID) were first initiated into injection by a current PWID. Few studies have examined PWID who assist others into drug injection. Our goal is to describe the prevalence of and risk factors for initiating someone into injection in the last 12 months. METHODS We recruited a cross-sectional sample of PWID (N=605) in California from 2011 to 2013. We examined bivariate and multivariate risk factors for initiating someone into injection with a focus on behaviors that might encourage injection initiation such as injecting in front of non-PWID, describing how to inject to non-PWID, and willingness to initiate someone into drug injection. RESULTS Having initiated someone into injection was reported by 34% of PWID overall and 7% in the last 12 months. Forty-four PWID had assisted 431 people into injection in the past year. Factors independently associated with initiating someone into injection in the last 12 months were self-reported likelihood of initiating someone in the future (Adjusted Odds Ratio [AOR]=7.09; 95% Confidence Interval [CI]=3.40, 14.79), having injected another PWID in past month (AOR=4.05; 95% confidence interval [CI]=1.94, 8.47), having described how to inject to non-injectors (2.61; 95% CI=1.19, 5.71), and non-injection powder cocaine use in past month (AOR=4.97; 95% CI=2.08, 11.84) while controlling for study site. CONCLUSION Active PWID are important in facilitating the process of drug injection uptake. Interventions to reduce initiation should include efforts to change behaviors and intentions among PWID that are associated with injection uptake among others.
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Affiliation(s)
- Ricky N Bluthenthal
- Department of Preventive Medicine, Institute for Prevention Research, Keck School of Medicine, University of Southern California Soto Street Building, SSB 2001 N. Soto Street, MC 9239, Los Angeles, CA 90033, USA.
| | - Lynn Wenger
- Urban Health Program, RTI International, 351 California St., San Francisco, CA 94104
| | - Daniel Chu
- Urban Health Program, RTI International, 351 California St., San Francisco, CA 94104
| | - Brendan Quinn
- Centre for Population Health, Burnet Institute, 85 Commercial Rd., Melbourne, VIC, 3004, Australia
| | - James Thing
- Department of Preventive Medicine, Institute for Prevention Research, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089
| | - Alex H Kral
- Urban Health Program, RTI International, 351 California St., San Francisco, CA 94104
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Bridge J. Route transition interventions: potential public health gains from reducing or preventing injecting. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2010; 21:125-8. [PMID: 20167464 DOI: 10.1016/j.drugpo.2010.01.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 01/25/2010] [Accepted: 01/25/2010] [Indexed: 11/15/2022]
Abstract
Multiple factors are implicated in the diffusion of injecting drug use (IDU), including individual and demographic characteristics, drug markets, economics, social networks and political and cultural environments. However, studies show that individual transitions away from injecting are possible, and that a recent diffusion of non-injecting routes of administration (NIROA) has occurred in several countries. Injecting is more risk-laden than other routes of drug administration, yet relatively little attention has been paid to reducing or preventing injecting drug use by promoting NIROA. This commentary reviews the case for, and examples of, 'route transition interventions' which seek to do this. These include: prescribing oral substitutes; providing non-injecting equipment; providing safer smoking facilities; and training individuals to prevent transitions to injecting, promote NIROA, or prevent the initiation of new injectors. These initiatives have the potential-as yet largely unrealised-to offer public health gains and empower people to control and manage their drug use. Further research is needed to secure commitments at all levels to support this approach.
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Affiliation(s)
- Jamie Bridge
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Switzerland.
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