Author:
Sibley Adams L.,Klein Emma,Cooper Hannah L.F.,Livingston Melvin D.,Baker Robin,Walters Suzan M.,Gicquelais Rachel E.,Ruderman Stephanie A.,Friedmann Peter D.,Jenkins Wiley D.,Go Vivian F.,Miller William C.,Westergaard Ryan P.,Crane Heidi M
Abstract
Abstract
Background
Drug overdose deaths in the United States exceeded 100,000 in 2021 and 2022. Substance use stigma is a major barrier to treatment and harm reduction utilization and is a priority target in ending the overdose epidemic. However, little is known about the relationship between stigma and overdose, especially in rural areas. We aimed to characterize the association between felt stigma and non-fatal overdose in a multi-state sample of rural-dwelling people who use drugs.
Methods
Between January 2018 and March 2020, 2,608 people reporting past 30-day opioid use were recruited via modified chain-referral sampling in rural areas across 10 states. Participants completed a computer-assisted survey of substance use and substance-related attitudes, behaviors, and experiences. We used multivariable logistic regression with generalized estimating equations to test the association between felt stigma and recent non-fatal overdose.
Results
6.6% of participants (n = 173) reported an overdose in the past 30 days. Recent non-fatal overdose was significantly associated with felt stigma after adjusting for demographic and substance use-related covariates (aOR: 1.47, 95% CI: 1.20–1.81). The association remained significant in sensitivity analyses on component fear of enacted stigma items (aOR: 1.48, 95% CI: 1.20–1.83) and an internalized stigma item (aOR: 1.51, 95% CI: 1.07–2.14).
Conclusions
Felt stigma related to substance use is associated with higher risk of non-fatal overdose in rural-dwelling people who use drugs. Stigma reduction interventions and tailored services for those experiencing high stigma are underutilized approaches that may mitigate overdose risk.
Funder
National Institutes of Health
Publisher
Springer Science and Business Media LLC
Reference142 articles.
1. Centers for Disease Control &, Prevention US, Overdose Deaths. In 2021 Increased Half as Much as in 2020 - But Are Still Up 15% [Internet]. 2022 [cited 2022 Oct 15]. Available from: https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/202205.htm.
2. National Emergency Medical Services Information System. NEMSIS. 2023 [cited 2023 May 26]. Opioid Overdose Tracker. Available from: https://nemsis-aws.org/opioid-overdose-tracker/.
3. Coben JH, Tiesman HM, Bossarte RM, Furbee PM. Rural-urban differences in injury hospitalizations in the U.S., 2004. Am J Prev Med. 2009;36(1):49–55.
4. Keyes KM, Cerdá M, Brady JE, Havens JR, Galea S. Understanding the rural-urban differences in nonmedical prescription opioid use and abuse in the United States. Am J Public Health. 2014;104(2):e52–9.
5. Leff M, Stallones L, Keefe TJ, Rosenblatt R, Reeds M. Comparison of urban and rural non-fatal injury: the results of a statewide survey. Inj Prev. 2003;9(4):332–7.