Mechanisms for Expanding Harm Reduction for Opioid Use in Suburban and Rural U.S. Settings

Abstract

The availability and adoption of Syringe Services Programs (SSPs) depends heavily on the towns and counties charged with implementing and sustaining these programs. Suburban and rural areas especially lack the community and political support for SSPs. We examined key informant in-depth interview data among professionals providing harm reduction services as well as some health department directors, doctors, and law enforcement officers from a three-state (Connecticut, Kentucky, and Wisconsin) study. Results revealed the challenges and emerging solutions for expanding harm reduction services in suburban and rural areas. Additional comparisons of experiences of those working in urban areas were highlighted. Overall, there were widespread similarities in challenges across the three states for providing harm reduction services in rural and suburban settings. Findings revealed potential directions to address the identified barriers and community-supported ideas to improve harm reduction efforts.

Keywords

syringe service programs suburban rural harm reduction

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References

Allen

S. T.

Ruiz

M. S.

O’Rourke

(2015). The evidence does not speak for itself: The role of research evidence in shaping policy change for the implementation of publicly funded syringe exchange programs in three US cities. International Journal of Drug Policy, 26(7), 688–695. https://doi.org/10.1016/j.drugpo.2015.04.008

Anderson

Clancy

Flynn

Kral

Bluthenthal

(2003). Delivering syringe exchange services through “satellite exchangers”: the sacramento area needle exchange, USA. International Journal of Drug Policy, 14(5–6), 461–463. https://doi.org/10.1016/s0955-3959(03)00146-4

Armstrong-Mensah

Dada

Rupasinghe

Whately

(2021). Injecting substance use in prisons in the United States: A case for needle exchange programs. The American Journal of Drug and Alcohol Abuse, 47(3), 273–279. https://www.tandfonline.com/doi/full/10.1080/00952990.2021.1872587

Artus

(2020). No questions asked: Needle exchange programs have quietly saved lives in Wisconsin for decades. Retrieved from https://isthmus.com/news/cover-story/no-questions-asked/

Baker

L. S.

Smith

Gulley

Tomann

M. M.

(2020). Community perceptions of comprehensive harm reduction programs and stigma towards people who inject drugs in rural virginia. J Community Health, 45(2), 239–244. https://doi.org/10.1007/s10900-019-00732-8

Behrends

C. N.

C.-S.

Gibson

D. R.

(2017). Decreased odds of injection risk behavior associated with direct versus indirect use of syringe exchange: evidence from two california cities. Substance Use & Misuse, 52(9), 1151–1159. https://doi.org/10.1080/10826084.2017.1299182

Behrends

C. N.

Corry

G. J.

LaKosky

Prohaska

S. M.

Glick

S. N.

Des Jarlais

D. C.

(2022). Harm reduction and health services provided by syringe services programs in 2019 and subsequent impact of COVID-19 on services in 2020. Drug and Alcohol Dependence, 232(109323), 1–8. https://doi.org/10.1016/j.drugalcdep.2022.109323

Bixler

Corby-Lee

Proescholdbell

Ramirez

Kilkenny

M. E.

LaRocco

Asher

(2018). Access to syringe services programs - kentucky, North Carolina, and West Virginia, 2013-2017. MMWR. Morbidity & Mortality Weekly Report, 67(18), 529–532. https://doi.org/10.15585/mmwr.mm6718a5

Castillo

(2018). Harm reduction strategies for the opiod crisis. North Carolina Medical Journal, 79(3), 192–194. https://doi.org/10.18043/ncm.79.3.192

10.

Centers for Disease Control & Prevention (2019). Federal funding for syringe services programs. Retrieved from https://www.cdc.gov/ssp/ssp-funding.html#:˜:text=Currentfederallawprohibitstheuseofdrugsbyinjection

11.

Davidson

P. J.

Scholar

Howe

(2011). A GIS-based methodology for improving needle exchange service delivery. International Journal of Drug Policy, 22(2), 140–144. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3070054/pdf/nihms-256591.pdf

12.

Des Jarlais

D. C.

Paone

Friedman

S. R.

Peyser

Newman

R. G.

(1995). Regulating controversial programs for unpopular people: Methadone maintenance and syringe exchange programs. American Journal of Public Health, 85(11), 1577–1584. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1615684/pdf/amjph00449-0107.pdf

13.

Des Jarlais

D. C.

Nugent

Solberg

Feelemyer

Mermin

Holtzman

(2015). Syringe service programs for persons who inject drugs in urban, suburban, and rural areas - United States, 2013. MMWR. Morbidity & Mortality Weekly Report, 64(48), 1337–1341. https://doi.org/10.15585/mmwr.mm6448a3

14.

Des Jarlais

D. C.

(2004). Public funding of US syringe exchange programs. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 81(1), 118–121. https://doi.org/10.1093/jurban/jth093

15.

Des Jarlais

D. C.

(2017). Harm reduction in the USA: The research perspective and an archive to David Purchase. Harm Reduction Journal, 14(1), 51. https://doi.org/10.1186/s12954-017-0178-6

16.

Eversman

M. H.

(2015). We want a living solution”: Views of harm reduction programs in black U.S. communities. Journal of Ethnicity in Substance Abuse, 14(2), 187–207. https://doi.org/10.1080/15332640.2014.976803

17.

Fernandes

R. M.

Cary

Duarte

Jesus

Alarcão

Torre

Carneiro

A. V.

(2017). Effectiveness of needle and syringe programmes in people who inject drugs–An overview of systematic reviews. BMC Public Health, 17(1), 1–15. https://doi.org/10.1186/s12889-017-4210-2

18.

Fernández-Viña

M. H.

Prood

N. E.

Herpolsheimer

Waimberg

Burris

(2020). State laws governing syringe services programs and participant syringe possession, 2014–2019. Public Health Reports, 135(Suppl 1), 128S–137S. https://doi.org/10.1177/0033354920921817

19.

Green

T. C.

Martin

E. G.

Bowman

S. E.

Mann

M. R.

Beletsky

(2012). Life after the ban: an assessment of US syringe exchange programs’ attitudes about and early experiences with federal funding. American Journal of Public Health, 102(5), e9–e16. https://doi.org/10.2105/AJPH.2011.300595

20.

Guy

G. P.

Haegerich

T. M.

Evans

M. E.

Losby

J. L.

Young

Jones

C. M.

(2019). Vital signs: Pharmacy-based naloxone dispensing—United States, 2012–2018. MMWR. Morbidity & Mortality Weekly Report, 68(31), 679–686. https://doi.org/10.15585/mmwr.mm6831e1

21.

Heller

Paone

(2011). Access to sterile syringes for injecting drug users in New York City: Politics and perception (1984–2010). Substance Use & Misuse, 46(2–3), 140–149. https://doi.org/10.3109/10826084.2011.523319

22.

Ibragimov

Cooper

K. E.

Batty

Ballard

A. M.

Fadanelli

Gross

S. B.

Cooper

H. L. F.

(2021). Factors that influence enrollment in syringe services programs in rural areas: A qualitative study among program clients in Appalachian Kentucky. Harm Reduction Journal, 18(1), 68. https://doi.org/10.1186/s12954-021-00518-z

23.

Joffe

(2011). Thematic analysis. In Thompson

A. R.

Harper

(Eds.), Qualitative research methods in mental health and psychotherapy (pp. 209–223). Hoboken, NJ: Wiley. https://doi.org/10.1002/9781119973249.ch15

24.

Jones

C. M.

(2019). Syringe services programs: An examination of legal, policy, and funding barriers in the midst of the evolving opioid crisis in the U.S. International Journal of Drug Policy, 70(2), 22–32. https://doi.org/10.1016/j.drugpo.2019.04.006

25.

Keyes

K. M.

Cerdá

Brady

J. E.

Havens

J. R.

Galea

(2014). Understanding the rural–urban differences in nonmedical prescription opioid use and abuse in the United States. American Journal of Public Health, 104(2), e52–e59. https://doi.org/10.2105/ajph.2013.301709

26.

Meyerson

B. E.

Lawrence

C. A.

Miller

Gillespie

Raymond

Kelley

Shannon

D. J.

(2017). Against the odds: Syringe exchange policy implementation in Indiana. AIDS and Behavior, 21(4), 973–981. https://doi.org/10.1007/s10461-017-1688-7

27.

Murphy

Kelley

M. S.

Lune

(2004). The health benefits of secondary syringe exchange. Journal of Drug Issues, 34(2), 245–268. https://doi.org/10.1177/002204260403400201

28.

Newland

Newman

Treloar

(2016). We get by with a little help from our friends”: Small-scale informal and large-scale formal peer distribution networks of sterile injecting equipment in Australia. International Journal of Drug Policy, 34, 65–71. https://doi.org/10.1016/j.drugpo.2016.04.005

29.

Novick

L. F.

Staley

Novick

C. G.

(2019). Developing safe syringe exchange programs. Journal of Public Health Management and Practice: JPHMP, 25(4), 390–397. https://doi.org/10.1097/phh.0000000000001003

30.

Polomarkakis

K. A.

(2017). Drug law enforcement revisited: The “War” against the war on drugs. Journal of Drug Issues, 47(3), 396–404. https://doi.org/10.1177/0022042617697017

31.

Rezaei

Ghiasvand

Higgs

Noroozi

Rezaei

Bayani

(2020). Factors associated with injecting-related risk behaviors among people who inject drugs: A systematic review and meta-analysis study. Journal of Addictive Diseases, 38(4), 420–437. https://www.tandfonline.com/doi/full/10.1080/10550887.2020.1781346

32.

Rigg

K. K.

Monnat

S. M.

Chavez

M. N.

(2018). Opioid-related mortality in rural America: Geographic heterogeneity and intervention strategies. The International Journal on Drug Policy, 57, 119–129. https://doi.org/10.1016/j.drugpo.2018.04.011

33.

Sharp

Barnett

J. T.

Vroom

E. B.

(2020). Community perceptions of harm reduction and its implications for syringe exchange policy. Journal of Drug Issues, 50(4), 507–523. https://journals.sagepub.com/doi/pdf/10.1177/0022042620932289

34.

Showalter

(2018). Federal funding for syringe exchange in the US: Explaining a long-term policy failure. International Journal of Drug Policy, 55, 95–104. https://doi.org/10.1016/j.drugpo.2018.02.006

35.

Soria

Johnson

Collins

Corby-Lee

Thacker

White

Thornton

(2021). Risk factors for loss to follow-up of persons who inject drugs enrolled at syringe services programs in Kentucky. International Journal of Drug Policy, 95(103255), 1–3. https://doi.org/10.1016/j.drugpo.2021.103255

36.

Strike

Miskovic

(2018). Scoping out the literature on mobile needle and syringe programs—review of service delivery and client characteristics, operation, utilization, referrals, and impact. Harm Reduction Journal, 15(1), 1–15. https://doi.org/10.1186/s12954-018-0212-3

37.

Tempalski

Flom

P. L.

Friedman

S. R.

Des Jarlais

D. C.

Friedman

J. J.

McKnight

Friedman

(2007). Social and political factors predicting the presence of syringe exchange programs in 96 US metropolitan areas. American Journal of Public Health, 97(3), 437–447. https://doi.org/10.2105/AJPH.2005.065961

38.

Teshale

E. H.

Asher

Aslam

M. V.

Augustine

Duncan

Rose-Wood

Dietz

P. M.

(2019). Estimated cost of comprehensive syringe service program in the United States. PloS One, 14(4), e0216205. https://doi.org/10.1371/journal.pone.0216205

39.

Treloar

Rance

Yates

Mao

(2016). Trust and people who inject drugs: The perspectives of clients and staff of needle syringe programs. International Journal of Drug Policy, 27, 138–145. https://doi.org/10.1016/j.drugpo.2015.08.018

40.

Voytek

Sherman

S. G.

Junge

(2003). A matter of convenience: Factors influencing secondary syringe exchange in Baltimore, Maryland, USA. International Journal of Drug Policy, 14(5), 465–467. https://doi.org/10.1016/S0955-3959(03)00147-6

41.

Wang

S.-C.

Maher

(2019). Substance use disorder, intravenous injection, and HIV infection: A review. Cell Transplantation, 28(12), 1465–1471. https://doi.org/10.1177/0963689719878380

42.

Weinmeyer

(2016). Needle exchange programs’ status in US politics. AMA Journal of Ethics, 18(3), 252–257. https://journalofethics.ama-assn.org/sites/journalofethics.ama-assn.org/files/2018-05/hlaw1-1603.pdf

43.

Whiteman

Burnett

Handanagic

Wejnert

Broz

(2020). Distance matters: The association of proximity to syringe services programs with sharing of syringes and injecting equipment - 17 U.S. cities, 2015. International Journal of Drug Policy, 85(102923), 1–8. https://doi.org/10.1016/j.drugpo.2020.102923

44.

Wiessing

Ferri

Běláčková

Carrieri

Friedman

S. R.

Folch

Griffiths

(2017). Monitoring quality and coverage of harm reduction services for people who use drugs: A consensus study. Harm Reduction Journal, 14(1), 19. https://doi.org/10.1186/s12954-017-0141-6