Utilization of Kentucky Syringe Service Programs in a Justice-Involved Sample of People Who Inject Drugs

Abstract

Residents of Kentucky are at-risk for harms related to the opioid epidemic and involvement in the criminal legal system (CLS) further increases those risks. In 2015, Kentucky legalized syringe service programs (SSPs) to provide low-threshold access to harm reduction services including syringe exchange, naloxone distribution, and linkage to care. The Behavioral Model for Vulnerable Populations (Gelberg et al., 2000) was used to investigate factors associated with SSP utilization among people who inject drugs involved in the CLS in Kentucky. One traditional predisposing factor (high school education/GED), one vulnerable need factor (injection drug use in the six months prior to incarceration), two traditional enabling factors (access to public transportation, incarceration after SSPs legalized for one year), and one vulnerable enabling (having used naloxone on someone else) were associated with SSP utilization. Results of this study highlight future directions for research on SSP utilization among people who are involved in the CLS.

Keywords

syringe service program behavioral model for vulnerable populations opioid justice system

Get full access to this article

View all access options for this article.

References

Andersen

R. M.

(1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36(1), 1–10. https://doi.org/10.2307/2137284

Ballard

A. M.

Falk

Greenwood

Gugerty

Feinberg

Friedmann

P. D.

V. F.

Jenkins

W. D.

Korthuis

P. T.

Miller

W. C.

Pho

M. T.

Seal

D. W.

Smith

G. S.

Stopka

T. J.

Westergaard

R. P.

Zule

W. A.

Young

A. M.

Cooper

H. L.

(2023). Houselessness and syringe service program utilization among people who inject drugs in eight rural areas across the USA: A cross-sectional analysis. Harm Reduction Journal, 20(1), 157. https://doi.org/10.1186/s12954-023-00892-w

Barocas

J. A.

Baker

Hull

S. J.

Stokes

Westergaard

R. P.

(2015). High uptake of naloxone-based overdose prevention training among previously incarcerated syringe-exchange program participants. Drug and Alcohol Dependence, 154, 283–286. https://doi.org/10.1016/j.drugalcdep.2015.06.023

Binswanger

I. A.

Blatchford

P. J.

Forsyth

S. J.

Stern

M. F.

Kinner

S. A.

(2016). Epidemiology of infectious disease-related death after release from prison, Washington State, United States, and Queensland, Australia: A cohort study. Public Health Reports, 131(4), 574–582. https://doi.org/10.1177/0033354916662216

Brothers

(2016). Merchants, samaritans, and public health workers: Secondary syringe exchanger discursive practices. International Journal of Drug Policy, 37, 1–8. https://doi.org/10.1016/j.drugpo.2016.06.004

Bryant

Hopwood

(2009). Secondary exchange of sterile injecting equipment in a high distribution environment: A mixed method analysis in south east Sydney, Australia—ClinicalKey. International Journal of Drug Policy, 20(4), 324–328. https://doi.org/10.1016/j.drugpo.2008.06.006

Bushling

Walton

M. T.

Conner

K. L.

Liu

Hoven

Joseph

Taylor

(2022). Syringe services programs in the Bluegrass: Evidence of population health benefits using Kentucky Medicaid data. The Journal of Rural Health: Official Journal of the American Rural Health Association and the National Rural Health Care Association, 38(3), 467–673. https://doi.org/10.1111/jrh.12623

Centers for Disease Control and Prevention . (2021). Infectious diseases, opioids and injection drug use. https://www.cdc.gov/pwid/opioid-use.html

Centers for Disease Control and Prevention . (2022). Drug overdose mortality by state. National Center for Health Statistics. https://www.cdc.gov/nchs/pressroom/sosmap/drug_poisoning_mortality/drug_poisoning.htm

10.

Centers for Disease Control and Prevention . (2023). Understanding the opioid overdose epidemic. https://www.cdc.gov/opioids/basics/epidemic.html

11.

Cloud

D. H.

Ibragimov

Prood

Young

A. M.

Cooper

H. L. F.

(2019). Rural risk environments for hepatitis c among young adults in appalachian Kentucky. International Journal of Drug Policy, 72, 47–54. https://doi.org/10.1016/j.drugpo.2019.05.006

12.

Craine

Hickman

Parry

J. V.

Smith

McDonald

Lyons

(2010). Characteristics of injecting drug users accessing different types of needle and syringe programme or using secondary distribution. Journal of Public Health, 32(3), 328–335. https://doi.org/10.1093/pubmed/fdp131

13.

Dennis

M. L.

White

M. K.

Titus

J. C.

Unsicker

J. I.

(2008). Global appraisal of individual needs: Administration guide for the GAIN and related measures. Chestnut Health Systems.

14.

Des Jarlais

Nugent

Solberg

Feelemyer

Mermin

Holtzman

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

15.

Deryabina

El-Sadr

W. M.

(2017). Uptake of needle and syringe program services in the Kyrgyz Republic: Key barriers and facilitators. Drug and Alcohol Dependence, 179, 180–186. https://doi.org/10.1016/j.drugalcdep.2017.07.002

16.

Des Jarlais

D. C.

McKnight

Goldblatt

Purchase

(2009). Doing harm reduction better: Syringe exchange in the United States. Addiction, 104(9), 1441–1446. https://doi.org/10.1111/j.1360-0443.2008.02465.x

17.

Duong

Dulcher

Freeman

P. R.

Young

A. M.

Cooper

H. L. F.

(2022). Attitudes toward pharmacy-based HCV/HIV testing among people who use drugs in rural Kentucky. The Journal of Rural Health, 38(1), 93–99. https://doi.org/10.1111/jrh.12564

18.

GAIN Coordinating Center . (2011). GAIN-I encyclopedia of supplemental documentation on scales and other calculated variables [Electronic version]. Chestnut Health Systems. https://chestnut.app.box.com/v/GAINCCWeb/file/63676210589

19.

Gelberg

Andersen

R. M.

Leake

B. D.

(2000). The Behavioral Model for Vulnerable Populations: Application to medical care use and outcomes for homeless people. Health Services Research, 34(6), 1273–1302.

20.

Gindi

R. M.

Rucker

M. G.

Serio-Chapman

C. E.

Sherman

S. G.

(2009). Utilization patterns and correlates of retention among clients of the needle exchange program in Baltimore, Maryland. Drug and Alcohol Dependence, 103(3), 93–98. https://doi.org/10.1016/j.drugalcdep.2008.12.018

21.

Harris

P. A.

Taylor

Minor

Elliott

Fernandez

O’Neal

McLeod

Delacqua

Kirby

Duda

S.REDCap Consortium.

(2019). The REDCap consortium: Building an international community of software platform partners. Journal of Biomedical Informatics, 95, Article 103208. https://doi.org/10.1016/j.jbi.2019.103208

22.

Harris

P. A.

Taylor

Thielke

Payne

Gonzalez

Conde

J. G.

(2009). Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42(2), 377–381. https://doi.org/10.1016/j.jbi.2008.08.010

23.

Heidari

Tormohlen

Dangerfield II

D. T.

Tobin

K. E.

Farley

J. E.

Aronowitz

S. V.

(2023). Barriers and facilitators to primary care engagement for people who inject drugs: A systematic review. Journal of Nursing Scholarship: An Official Publication of Sigma Theta Tau International Honor Society of Nursing, 55(3), 605–622. https://doi.org/10.1111/jnu.12863

24.

Hoffman

K. A.

Thompson

Gaeta Gazzola

Oberleitner

L. M. S.

Eller

Madden

L. M.

Marcus

Oberleitner

D. E.

Beitel

Barry

D. T.

(2023). “Just fighting for my life to stay alive”: A qualitative investigation of barriers and facilitators to community re-entry among people with opioid use disorder and incarceration histories. Addiction Science & Clinical Practice, 18(1), 16. https://doi.org/10.1186/s13722-023-00377-y

25.

Ibragimov

Cooper

K. E.

Batty

Ballard

A. M.

Fadanelli

Gross

S. B.

Klein

E. M.

Lockard

Young

A. M.

Cooper

H. L. F.

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

26.

Kaeble

(2021). Time served in state prison, 2018. U.S. Department of Justice, Bureau of Justice Statistics. https://bjs.ojp.gov/content/pub/pdf/tssp18.pdf

27.

Kaplowitz

Truong

Macmadu

Berk

Martin

Burke

Rich

J. D.

Brinkley-Rubinstein

(2023). Anticipated barriers to sustained engagement in treatment with medications for opioid use disorder after release from incarceration. Journal of Addiction Medicine, 17(1), 54–59. https://doi.org/10.1097/ADM.0000000000001029

28.

Kingery

K. L.

(2018). County health rankings & roadmaps. Journal of Youth Development, 13(3), 259–263. https://doi.org/10.5195/jyd.2018.649

29.

Krawczyk

Schneider

K. E.

Eisenberg

M. D.

Richards

T. M.

Ferris

Mojtabai

Stuart

E. A.

Lyons

B. C.

Jackson

Weiner

J. P.

Saloner

(2020). Opioid overdose death following criminal justice involvement: Linking statewide corrections and hospital databases to detect individuals at highest risk. Drug and Alcohol Dependence, 213, 107997. https://doi.org/10.1016/j.drugalcdep.2020.107997

30.

Kubany

E. S.

Leisen

M. B.

Kaplan

A. S.

Watson

S. B.

Haynes

S. N.

Burns

Owens

J. A.

(2000). Development and preliminary validation of a brief broad-spectrum measure of trauma exposure: The Traumatic Life Events Questionnaire. Psychological Assessment, 12(2), 210–224. https://doi.org/10.1037//1040-3590.12.2.210

31.

KY CHFS . (2024). Syringe service programs. Kentucky Cabinet for Health and Family Services.

32.

Lancaster

K. E.

Cooper

H. L. F.

Browning

C. R.

Malvestutto

C. D.

Bridges

J. F. P.

Young

A. M.

(2020). Syringe service program utilization, barriers, and preferences for design in rural Appalachia: Differences between men and women who inject drugs. Substance Use & Misuse, 55(14), 2268–2277. https://doi.org/10.1080/10826084.2020.1800741

33.

Lewis

A. H.

Ford

J. A.

(2024). Healthcare utilization and type of criminal-legal system contact: The importance of employment and health insurance. Journal of Criminal Justice, 93, 102211. https://doi.org/10.1016/j.jcrimjus.2024.102211

34.

Nambiar

Stoové

Dietze

(2014). A cross-sectional study describing factors associated with utilisation of GP services by a cohort of people who inject drugs. BMC Health Services Research, 14(1), 308. https://doi.org/10.1186/1472-6963-14-308

35.

Nijhawan

A. E.

(2016). Infectious diseases and the criminal justice system. The American Journal of the Medical Sciences, 352(4), 399–407. https://doi.org/10.1016/j.amjms.2016.05.020

36.

Oser

C. B.

Batty

Booty

Eddens

Knudsen

H. K.

Perry

Rockett

Staton

(2023). Social ecological factors and medication treatment for opioid use disorder among justice-involved rural and urban persons: The Geographic variation in Addiction Treatment Experiences (GATE) longitudinal cohort study protocol. BMJ Open, 13(3), Article e066068. https://doi.org/10.1136/bmjopen-2022-066068

37.

Oser

C. B.

Bunting

A. M.

Pullen

Stevens-Watkins

(2016). African American female offender’s use of alternative and traditional health services after Re-entry: Examining the behavioral model for vulnerable populations. Journal of Health Care for the Poor and Underserved, 27(2A), 120–148. https://doi.org/10.1353/hpu.2016.0052

38.

Peddireddy

S. R.

Livingston

M. D.

Young

A. M.

Freeman

P. R.

Ibragimov

Komro

K. A.

Lofwall

M. R.

Oser

C. B.

Staton

Cooper

H. L. F.

(2024). Willingness to utilize a mobile treatment unit in five counties at the epicenter of the US rural opioid epidemic. Journal of Substance Use and Addiction Treatment, 159, Article 209262. https://doi.org/10.1016/j.josat.2023.209262

39.

Pennanen

Broms

Korhonen

Haukkala

Partonen

Tuulio-Henriksson

Laatikainen

Patja

Kaprio

(2014). Smoking, nicotine dependence and nicotine intake by socio-economic status and marital status. Addictive Behaviors, 39(7), 1145–1151. https://doi.org/10.1016/j.addbeh.2014.03.005

40.

Ranjbar

E. M.

Khosravi

Bahrami

M. A.

Rafiei

(2018). Socio-economic inequalities in health services utilization: A cross-sectional study. International Journal of Health Care Quality Assurance, 31(1), 69–75. https://doi.org/10.1108/IJHCQA-04-2017-0059

41.

Riley

Junge

Marx

Strathdee

Vlahov

(2002). Health services utilization by injection drug users participating in a needle exchange program. The American Journal of Drug and Alcohol Abuse, 28(3), 497–511. https://doi.org/10.1081/ADA-120006738

42.

Rowell-Cunsolo

T. L.

Bellerose

(2021). Utilization of substance use treatment among criminal justice-involved individuals in the United States. Journal of Substance Abuse Treatment, 125, 108423. https://doi.org/10.1016/j.jsat.2021.108423

43.

Starbird

L. E.

DiMaina

Sun

C. A.

Han

H. R.

(2019). A systematic review of interventions to minimize transportation barriers among people with chronic diseases. Journal of Community Health, 44(2), 400–411. https://doi.org/10.1007/s10900-018-0572-3

44.

Stull

D. E.

Leidy

N. K.

Parasuraman

Chassany

(2009). Optimal recall periods for patient-reported outcomes: Challenges and potential solutions. Current Medical Research and Opinion, 25(4), 929–942. https://doi.org/10.1185/03007990902774765

45.

Tookes

H. E.

Bartholomew

T. S.

Sugar

S. E. S.

Plesons

M. D.

Bluthenthal

R. N.

Wenger

L. D.

Patel

S. V.

Kral

A. H.

Lambdin

B. H.

(2024). Updates on syringe coverage and service uptake among needle and syringe programs in the United States, 2019–2020. International Journal of Drug Policy, 123, Article 104289. https://doi.org/10.1016/j.drugpo.2023.104289

46.

Turner-Bicknell

(2021). Implementing best-practice with a local syringe service program: Needs-based syringe distribution. Public Health Nursing, 38(1), 85–92. https://doi.org/10.1111/phn.12823

47.

USDA ERS . (2020). Rural-urban continuum codes. U.S. Department of Agriculture, Economic Research Service. https://www.ers.usda.gov/data-products/rural-urban-continuum-codes/

48.

Vatcheva

K. P.

Lee

McCormick

J. B.

Rahbar

M. H.

(2016). Multicollinearity in regression analyses conducted in epidemiologic studies. Epidemiology (Sunnyvale), 6(2), 227. https://doi.org/10.4172/2161-1165.1000227

49.

Victor

Kheibari

Staton

Oser

C. B.

(2018). Appalachian women’s use of substance abuse treatment: Examining the behavioral model for vulnerable populations. Journal of Social Work Practice in the Addictions, 18(2), 192–213. https://doi.org/10.1080/1533256X.2018.1450264

50.

Wallace

Hughes-Cromwick

Mull

Khasnabis

(2005). Access to health care and nonemergency medical transportation: Two missing links. Transportation Research Record: Journal of the Transportation Research Board, 1924(1), 76–84. https://doi.org/10.1177/0361198105192400110