N Jia Ahmad1, Sean T Allen2, Rebecca Hamilton White3, Kristin E Schneider4, Allison O'Rourke5, Michelle Perdue6, Charles Babcock7, Michael E Kilkenny6, Susan G Sherman3. 1. Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA. 2. Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA. Sallen63@jhu.edu. 3. Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA. 4. Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA. 5. DC Center for AIDS Research, Department of Psychological and Brain Sciences, George Washington University, 2125 G St. NW, Washington, DC, 20052, USA. 6. Cabell Huntington Health Department, 703 7th Ave., Huntington, WV, 25701, USA. 7. Marshall University School of Pharmacy, 1538 Charleston Ave., Huntington, WV, 25701, USA.
Abstract
AIM: Experiencing 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. METHODS: Using 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. RESULTS: The 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) CONCLUSIONS: A 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.
AIM: Experiencing a nonfatal overdose (NFOD) is a significant risk factor for a subsequent nonfatal or fatal overdose. Overdosemortality 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. METHODS: Using 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. RESULTS: The 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) CONCLUSIONS: A 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.
Entities:
Keywords:
Injection drug use; Overdose; Rural drug use
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