Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland.
Oregon Health & Science University-Portland State University School of Public Health, Portland.
JAMA Netw Open. 2023 Nov 1;6(11):e2342222. doi: 10.1001/jamanetworkopen.2023.42222.
Drug use and incarceration have a substantial impact on rural communities, but factors associated with the incarceration of rural people who use drugs (PWUD) have not been thoroughly investigated.
To characterize associations between recent incarceration, overdose, and substance use disorder (SUD) treatment access among rural PWUD.
DESIGN, SETTING, AND PARTICIPANTS: For this cross-sectional study, the Rural Opioid Initiative research consortium conducted a survey in geographically diverse rural counties with high rates of overdose across 10 US states (Illinois, Wisconsin, North Carolina, Oregon, Kentucky, West Virginia, Ohio, Massachusetts, New Hampshire, and Vermont) between January 25, 2018, and March 17, 2020, asking PWUD about their substance use, substance use treatment, and interactions with the criminal legal system. Participants were recruited through respondent-driven sampling in 8 rural US regions. Respondents who were willing to recruit additional respondents from their personal networks were enrolled at syringe service programs, community support organizations, and through direct community outreach; these so-called seed respondents then recruited others. Of 3044 respondents, 2935 included participants who resided in rural communities and reported past-30-day injection of any drug or use of opioids nonmedically via any route. Data were analyzed from February 8, 2022, to September 15, 2023.
Recent incarceration was the exposure of interest, defined as a report of incarceration in jail or prison for at least 1 day in the past 6 months.
The associations between PWUD who were recently incarcerated and main outcomes of treatment use and overdose were examined using logistic regression.
Of 2935 participants, 1662 (56.6%) were male, 2496 (85.0%) were White; the mean (SD) age was 36 (10) years; and in the past 30 days, 2507 (85.4%) reported opioid use and 1663 (56.7%) reported injecting drugs daily. A total of 1224 participants (41.7%) reported recent incarceration, with a median (IQR) incarceration of 15 (3-60) days in the past 6 months. Recent incarceration was associated with past-6-month overdose (adjusted odds ratio [AOR], 1.38; 95% CI, 1.12-1.70) and recent SUD treatment (AOR, 1.62; 95% CI, 1.36-1.93) but not recent medication for opioid use disorder (MOUD; AOR, 1.03; 95% CI, 0.82-1.28) or currently carrying naloxone (AOR, 1.02; 95% CI, 0.86-1.21).
In this cross-sectional study of PWUD in rural areas, participants commonly experienced recent incarceration, which was not associated with MOUD, an effective and lifesaving treatment. The criminal legal system should implement effective SUD treatment in rural areas, including MOUD and provision of naloxone, to fully align with evidence-based SUD health care policies.
药物使用和监禁对农村社区有重大影响，但与农村吸毒者（PWUD）监禁相关的因素尚未得到彻底调查。
描述最近监禁、过量用药和农村吸毒者获得物质使用障碍（SUD）治疗之间的关联。
设计、地点和参与者：在这项具有代表性的研究中，农村阿片类药物倡议研究联盟在 10 个美国州（伊利诺伊州、威斯康星州、北卡罗来纳州、俄勒冈州、肯塔基州、西弗吉尼亚州、俄亥俄州、马萨诸塞州、新罕布什尔州和佛蒙特州）的地理多样化农村县进行了一项调查，这些县的过量用药率很高，调查对象为农村吸毒者，询问他们的物质使用、物质使用治疗情况以及与刑事法律系统的互动情况。参与者通过在 8 个美国农村地区的受访者驱动抽样招募。愿意从个人网络中招募更多受访者的参与者在注射器服务项目、社区支持组织和通过直接社区外联中登记；这些所谓的种子受访者随后招募了其他人。在 3044 名受访者中，有 2935 名受访者居住在农村社区，报告过去 30 天内有过任何药物注射或通过任何途径非医疗使用阿片类药物。数据分析于 2022 年 2 月 8 日至 2023 年 9 月 15 日进行。
最近监禁是感兴趣的暴露，定义为报告过去 6 个月内在监狱或监狱中监禁至少 1 天。
使用逻辑回归检查最近被监禁的 PWUD 与治疗使用和过量用药的主要结果之间的关联。
在 2935 名参与者中，1662 名（56.6%）为男性，2496 名（85.0%）为白人；平均（SD）年龄为 36（10）岁；在过去 30 天内，2507 名（85.4%）报告使用阿片类药物，1663 名（56.7%）报告每天注射药物。共有 1224 名参与者（41.7%）报告最近被监禁，过去 6 个月的监禁中位数（IQR）为 15（3-60）天。最近的监禁与过去 6 个月的过量用药（调整后的优势比[OR]，1.38；95%置信区间[CI]，1.12-1.70）和最近的 SUD 治疗（OR，1.62；95%CI，1.36-1.93）相关，但与最近的阿片类药物使用障碍药物治疗（OR，1.03；95%CI，0.82-1.28）或目前携带纳洛酮（OR，1.02；95%CI，0.86-1.21）无关。
在这项对农村地区吸毒者的具有代表性的研究中，参与者普遍经历过最近的监禁，但最近的监禁与有效的、救命的 SUD 治疗无关。刑事司法系统应在农村地区实施有效的 SUD 治疗，包括 MOUD 和提供纳洛酮，以完全符合循证 SUD 医疗保健政策。
