Abstract
AimExperiencing a nonfatal overdose (NFOD) is a significant risk factor for a subsequent nonfatal or fatal overdose. Overdose mortality rates in rural Appalachian states are some of the highest in the USA, but little is known about correlates of overdose among rural populations of people who inject drugs (PWID). Our study aimed to identify correlates of experiencing a recent (past 6 months) NFOD among rural PWID in Cabell County, West Virginia.MethodsUsing data from a June–July 2018 cross-sectional survey that was designed to estimate the size and characteristics of the PWID population in Cabell County, West Virginia, we used log binomial regression to identify correlates (e.g., structural vulnerabilities and substance use) of NFOD in the past 6 months.ResultsThe majority of our sample of 420 PWID were male (61.2%), White, non-Hispanic (83.6%), and reported recent heroin injection (81.0%). More than two-fifths (42.6%) experienced a recent NFOD. Independent correlates of NFOD included witnessing an overdose in the past 6 months (adjusted prevalence ratio [aPR] = 2.28; 95% CI 1.48–3.50), attempting to quit using drugs in the past 6 months (aPR = 1.54; 95% CI 1.11–2.14), and the number of drugs injected (aPR = 1.16; 95% CI 1.10–1.23)ConclusionsA large proportion of rural PWID in Appalachia reported having recently overdosed. The associations between witnessing an overdose, attempting to quit using drugs, and number of drugs injected with recent nonfatal overdose underscore the need for expanded access to overdose prevention resources that are tailored to the needs of this population. Expanding access to evidence-based overdose prevention strategies—such as take-home naloxone programs, treatment with methadone or buprenorphine, and harm reduction services—may decrease overdose morbidity and mortality among rural PWID in Appalachia.
Highlights
In 2017, there were an estimated 109,500 people who died of an opioid-related overdose globally, 43% of whom were in the USA [1]
We collected information about non-injection drug use, our analysis focuses on the number of drugs injected as injection drug use conveys a higher risk of overdose [40]
The majority of our sample of rural people who inject drugs (PWID) identified as White, non-Hispanic (83.6%), and male (61.2%) (Table 1)
Summary
In 2017, there were an estimated 109,500 people who died of an opioid-related overdose globally, 43% of whom were in the USA [1]. The opioid crisis has had a devastating impact on the health of Americans, decreasing life expectancy in the USA for three consecutive years [2]. Rural Appalachia is one of the regions that has been most severely impacted by the modern opioid crisis [3]. In West Virginia (WV), the opioid overdose death rate increased 12% annually between 2008 and 2016, and the state has had the highest age-adjusted opioid mortality rate in the USA for the past five consecutive reported years [4, 5]. A recent meta-analysis estimated that one-fifth of this population experienced an overdose in the past year [7]. Nonfatal overdose (NFOD) is an important public health concern, not
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