Rural Drug Use Research Articles

A Sociology of Empathy and Shared Understandings: Contextualizing Beliefs and Attitudes on Why People Use Opioids

AbstractThere has been a steep rise in overdoses and mortality among people who use opioids or who inject drugs (PWUD), including in North America, the United Kingdom, and parts of Eastern Europe, with some of the sharpest increases amassing in rural communities. Currently, the literature lacks a comparative focus on the views and experiences of rural PWUD and professionals who regularly work and interface with them, in terms of their understandings of the rural drug use initiation/relapse trajectory. Considering a renewed sociology of emotions and empathy and the constructs of direct experience (e.g., of personal drug use) versus role‐playing (e.g., envisioning oneself in another's position), we used a modified constant comparison method to analyze interviews conducted with PWUD and professional stakeholders in rural southern Illinois, an opioid overdose hotspot. Findings suggest that rural opioid use is adopted in service of an intricate interplay of sensory, relational, somatic, and psychosocial benefits, with a sharp divergence between PWUD, who express considerable agency in their drug use behaviors, and professionals, who fail to successful role‐play in emphasizing PWUD's limited willpower and “deviant” sociocultural predilection. These dynamics illuminate challenges to advancing nuanced, culturally humble programming to advance public health goals related to the opioid and drug injection epidemic.

Wastewater analysis reveals urban, suburban, and rural spatial patterns of illicit drug use in Dalian, China.

Illicit drug use in rural and suburban areas of China has not been studied extensively, as most studies have focused on illicit drug use in urban areas. To compare the differences between urban, suburban, and rural drug use, we collected influent samples from 19 urban, 9 suburban, and 18 rural wastewater treatment plants in Dalian, respectively. A method using solid-phase extraction combined with derivatization for gas chromatography -mass spectrometry analysis was applied to detect biomarker concentrations. The concentrations of methamphetamine and morphine ranged from 3.12 to 605ng/L and < 2.35 to 198ng/L, respectively. Norketamine was found in only four samples (5.56 to 14.5ng/L), while 3,4-methylenedioxymethamphetamine and benzoylecgonine were not detected in any samples. Methamphetamine use in rural areas (16.3mg/day/1000 inhabitant (inh), prevalence: 0.06%) was significantly lower than those in urban (77.1mg/day/1000 inh, prevalence: 0.23%) and suburban (234mg/day/1000 inh, prevalence: 0.70%) areas. Heroin use in suburban areas (57.6mg/day/1000 inh, prevalence: 0.10%) was significantly higher than that in urban (13.9mg/day/1000 inh, prevalence: 0.02%) and rural (8.68mg/day/1000 inh, prevalence: 0.02%) areas. The results indicate relatively low levels of illicit drug use in rural areas of Dalian, related to low incomes and outflow of the working-age population. Illicit drug use was most prevalent in suburban areas of Dalian, which may be influenced by large floating populations and few anti-drug efforts in suburban areas.

Injection Opioid and Injection Methamphetamine Use in the Rural United States: A Systematic Review and Network Analysis

The abuse of opioid and methamphetamine is a public health crisis in the United States, particularly in rural areas where injection drug use is common. This systematic review of rural injection drug use synthesized the research on injection of opioids and methamphetamine use and assessed the similarity of their research findings to the field of rural injection drug use in the United States. A citation network analysis was used to support the assessment of research similarity and provided a visualization of the field. This citation network analysis exposed a gap in the literature revealing that the state of research may not be fully applicable to the field in its entirety in the United States. In summary, this review provides a representative overview of the state of research in the field of injection drug use. Future research should conduct studies on rural drug use in areas of the country not represented in this review.

Network-Based Research on Rural Opioid Use: an Overview of Methods and Lessons Learned.

The purpose of this paper is to provide a thorough overview of methods used for recruitment, network data collection, and network data management in a network-based study of rural people who use drugs (PWUD) and to offer methodological recommendations for future research on rural drug use. The Social Networks among Appalachian People (SNAP) study recruited a cohort of 503 rural PWUD via respondent-driven sampling (RDS) and has retained more than 80% of eligible participants over 7-9years. SNAP has yielded important methodological insights, including that (1) RDS referral was non-random and disproportionately involved kin and (2) interviewer-administered questionnaires were successful in eliciting accurate name and age information about network members. The SNAP experience suggests that RDS was a successful recruitment strategy for rural PWUD and questionnaires administered by community-based interviewers in the context of a Certificate of Confidentiality could elicit detailed data on PWUD risk networks.

"The Many Parts of Recovery"

The nature and challenge of illicit drug use in the United States continues to change rapidly, evolving in reaction to myriad social, economic, and local forces. While the use of illicit drugs affects every region of the country, most of our current information about drug use comes from large urban areas. Data on rural drug use and its harms justify greater attention. Record overdose rates, unexpected outbreaks of HIV, and a dearth of treatment facilities point to a rapidly worsening health situation. While health sciences have made considerable progress in understanding the etiology of drug use and uncovering the link between drug use and its myriad associated harms, this promising scientific news has not always translated to better health outcomes. The scope of the problem in the Central Plains of the US is growing, and can be estimated from available sources. Clear remedies for this rising level of abuse are available, but few have been implemented. Suggestions for short-term policy remedies are discussed.

Bridging the Gaps between Needs and Services in the Health and Criminal Justice Systems: Szczecin Rpar Final Report and Recommendations

A Rapid Policy Assessment and Response (RPAR) intervention was conducted in Szczecin, Poland, to assess the impact of drug policy on the health of drug users in the city and surrounding rural areas. In the RPAR, a team of Polish researchers worked with a Community Action Board (CAB) comprised of law enforcement officials, drug treatment providers, medical officers, NGO leaders, lawyers, judges, and others to collect and analyze laws and policies relevant to health risks in the target populations; existing data on the epidemiological situation and the operation of the criminal justice system; and 3) qualitative interviews with health care providers, lawyers, law enforcement representatives, NGO staff, drug users, sex workers and others who describing how the laws are put into practice.The Szczecin RPAR uncovered evidence of dangerous new drug-use patterns, and significant gaps in the health and drug treatment services available to prevent HIV and other serious health problems among drug users. Key findings include:* Criminalizing drug possession in Poland has not fulfilled its goals in practice* A rise in rural drug use is creating serious unmet needs for prevention, treatment and disease surveillance.* Lack of therapy and HIV prevention methods in prison and difficulties in the social reintegration process* Lack of quality legal services in the criminal and civil justice systemsThe findings indicate that drug policy in practice does not correspond to the strategies embodied in recent Polish drug legislation, and that urgent action is necessary to prevent serious health problems in rural northwest Poland.

Drug (Ab)use Research among Rural African American Males: An Integrated Literature Review

Little is known about the cultural norms and prevalence of drug use and abuse among rural African American males. Rural drug use research among males tends to focus on Native American, white, or diverse racial/ethnic samples of adolescents and, to a much lesser extent, white adult males, with almost no targeting of African American males. Therefore, an extensive search of published literature on drug use among rural African American males was undertaken to identify and summarize the published research related to drug use among this population, with the ultimate goal of delineating research gaps warranting future investigation. Findings revealed that most studies focused on adolescents and children, often using national data sets, and were descriptive. Those that targeted adults frequently analyzed demographics for respondents who were rural, male, and/or African American, although all three characteristics were usually not reported in combination. Of these studies, the percentage of African American males varied, usually being the largest minority subgroup but still a relatively small percentage of each sample. Results specific to rural African American adult males are rarely reported in these studies. Recommendations for the direction of future drug use research among rural African American males are offered, and research gaps are identified.

Prescription Drug Use, Health Services Utilization, and Health Problems in Rural Appalachian Kentucky

Rural states like Kentucky now lead the nation in the illicit diversion of narcotic prescription drugs. In order to understand this phenomenon, we examine the currently popularly abused prescription drug OxyContin® by comparing differences in drug use, health services use, and criminality among a nontreatment group of rural Appalachian probationers who reported using OxyContin® (n = 101) with nonusers of OxyContin® (n = 194). Although OxyContin® users were younger, a number of differences emerged. OxyContin® users exhibited higher levels of use for 15 illicit drugs examined; used more detoxification services; attended more AA/NA meetings; reported more depression, anxiety, trouble concentrating, and violence; and reported more crime for 16 crimes. We discuss the implications of OxyContin® use including the possibility that it may be a marker for other illicit rural drug use.

RURAL-URBAN DIFFERENCES IN SUBSTANCE USE AND TREATMENT UTILIZATION AMONG PRISONERS

Surveys of incarcerated offenders and arrestees consistently report high rates of both alcohol and drug use in this population. This drug-crime connection has highlighted the need to learn more not only about drug treatment effectiveness, but also about drug treatment utilization. While studies have begun to examine drug treatment utilization, most of these studies have been based on urban substance abusers. Little is known about the extent to which urban and rural substance abusers may be different in terms of treatment utilization. This study, therefore, examines differences between urban and rural drug use patterns and treatment utilization among chronic drug abusers to determine whether, and in what ways, rurality may affect substance abuse and treatment seeking. The study examines these issues in a group of chronic drug users who were incarcerated at the time of the study. Findings show significant differences in drug use and treatment utilization of urban and rural offenders. Chronic drug abusers from rural and very rural areas have significantly higher rates of lifetime drug use, as well as higher rates of drug use in the 30 days prior to their current incarceration than chronic drug abusers from urban areas. Nonetheless, being from a very rural area decreased the likelihood of having ever been in treatment after controlling for the number of years using and race. While problem recognition appears to explain much of the effect of very rural residence on treatment utilization for alcohol abuse, the effects of being from a very rural area on seeking treatment for drug abuse remain statistically significant even after controlling for several other variables. The findings point to the importance of providing culturally appropriate education to very rural communities on the benefits of substance abuse treatment and of providing substance abuse treatment within the criminal justice system.

A Contextual Model of Adolescent Alcohol Use across the Rural-Urban Continuum

In the research presented here, we develop and test with respondents from a broad range of contexts a multilevel social control model of adolescent substance use, integrating macro- and microsociological and criminological perspectives. Specifically, this research examines the individual-level social control processes or mechanisms thought to lead to alcohol use embedded in school contexts in different community settings along the rural-urban continuum. In this way we determine 1) the main effects of individual- and contextual school-level variables and 2) the conditioning or moderating influences of school climate on individual alcohol use and on individual-level processes leading to alcohol use. Furthermore, given that our sample contains students from a broad range of settings along the rural-urban continuum, our findings address the appropriateness of conceptualizing rural and urban drug use and their respective etiologies as dichotomous. In this respect our findings suggest that heterogeneity in drug use exists within rural school settings as well as within urban school settings, and that examining rural drug use as separate from urban drug use is not justified. [Translations are provided in the International s Section of this issue.]

Drug Use by Small Town Mexican American Youth: A Pilot Study

While the quality of drug use data for youth of Spanish origin is improving, there is still inadequate information about Mexican American youth in rural areas of the Southwest. A pilot study is presented in which the youth of a small town in the Southwest were surveyed regarding their drug and alcohol use. Mexican American and Anglo youth within that sample are compared on drug use variables and differences by gender are examined. Further comparisons are made with a national sample and a group of urban barrio youth. The literature is reviewed for studies on drug use among youth of the various Spanish-origin groups, and small town and rural drug use.