Department of Public Health Sciences, Clemson University, Clemson, SC, 29634, USA.
Prisma Health Addiction Medicine Center, Greenville, SC, 29605, USA.
Subst Abuse Treat Prev Policy. 2023 Apr 19;18(1):23. doi: 10.1186/s13011-023-00532-3.
Rural areas in the United States (US) are ravaged by the opioid overdose epidemic. Oconee County, an entirely rural county in northwest South Carolina, is likewise severely affected. Lack of harm reduction and recovery resources (e.g., social capital) that could mitigate the worst outcomes may be exacerbating the problem. We aimed to identify demographic and other factors associated with support for harm reduction and recovery services in the community.
The Oconee County Opioid Response Taskforce conducted a 46-item survey targeting a general population between May and June in 2022, which was mainly distributed through social media networks. The survey included demographic factors and assessed attitudes and beliefs toward individuals with opioid use disorder (OUD) and medications for OUD, and support for harm reduction and recovery services, such as syringe services programs and safe consumption sites. We developed a Harm Reduction and Recovery Support Score (HRRSS), a composite score of nine items ranging from 0 to 9 to measure level of support for placement of naloxone in public places and harm reduction and recovery service sites. Primary statistical analysis using general linear regression models tested significance of differences in HRRSS between groups defined by item responses adjusting for demographic factors.
There were 338 survey responses: 67.5% were females, 52.1% were 55 years old or older, 87.3% were Whites, 83.1% were non-Hispanic, 53.0% were employed, and 53.8% had household income greater than US$50,000. The overall HRRSS was relatively low at a mean of 4.1 (SD = 2.3). Younger and employed respondents had significantly greater HRRSS. Among nine significant factors associated with HRRSS after adjusting for demographic factors, agreement that OUD is a disease had the greatest adjusted mean difference in HRSSS (adjusted diff = 1.22, 95% CI=(0.64, 1.80), p < 0.001), followed by effectiveness of medications for OUD (adjusted diff = 1.11, 95%CI=(0.50, 1.71), p < 0.001).
Low HRRSS indicates low levels of acceptance of harm reduction potentially impacting both intangible and tangible social capital as it relates to mitigation of the opioid overdose epidemic. Increasing community awareness of the disease model of OUD and the effectiveness of medications for OUD, especially among older and unemployed populations, could be a step toward improving community uptake of the harm reduction and recovery service resources critical to individual recovery efforts.
美国（US）农村地区深受阿片类药物过量流行的影响。南卡罗来纳州西北部的一个完全农村的奥科尼县同样受到严重影响。缺乏可能减轻最严重后果的减少伤害和恢复资源（例如社会资本）可能会使问题恶化。我们旨在确定与社区中减少伤害和恢复服务支持相关的人口统计和其他因素。
奥科尼县阿片类药物反应工作队在 2022 年 5 月至 6 月期间针对一般人群进行了一项 46 项调查，主要通过社交媒体网络进行分发。该调查包括人口统计因素，并评估了对阿片类药物使用障碍（OUD）个体和 OUD 药物的态度和信念，以及对减少伤害和恢复服务的支持，例如纳洛酮在公共场所的投放和减少伤害和恢复服务场所。我们开发了一个减少伤害和恢复支持评分（HRRSS），这是一个由九个项目组成的综合评分，范围从 0 到 9，用于衡量在公共场所和减少伤害和恢复服务场所放置纳洛酮以及减少伤害和恢复服务的支持程度。使用一般线性回归模型的主要统计分析测试了根据项目反应定义的组之间 HRRSS 差异的显著性，调整了人口统计因素。
共有 338 份调查回复：67.5%为女性，52.1%为 55 岁或以上，87.3%为白人，83.1%为非西班牙裔，53.0%为在职人员，53.8%的家庭收入超过 50,000 美元。总体 HRRSS 相对较低，平均为 4.1（SD=2.3）。年轻和在职的受访者 HRRSS 明显更高。在调整人口统计因素后与 HRRSS 相关的九个显著因素中，同意 OUD 是一种疾病的因素对 HRSSS 的调整平均差异最大（调整差异=1.22，95%CI=（0.64，1.80），p<0.001），其次是 OUD 药物的有效性（调整差异=1.11，95%CI=（0.50，1.71），p<0.001）。
低 HRRSS 表明对减少伤害的接受程度较低，这可能会对与减轻阿片类药物过量流行相关的无形和有形社会资本产生影响。提高社区对 OUD 的疾病模式和 OUD 药物有效性的认识，特别是在老年和失业人群中，可能是改善社区对减少伤害和恢复服务资源的接受度的一步，这些资源对个人的恢复努力至关重要。
