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Staton M, Tillson M, Levi MM, Webster M, Oser C, Leukefeld C. Screening Incarcerated Women for Opioid Use Disorder. JOURNAL OF DRUG ISSUES 2024; 54:57-73. [PMID: 38046434 PMCID: PMC10688603 DOI: 10.1177/00220426231151595] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
The overall aim of the present study is to examine the utility of the DSM OUD Checklist and the NM-ASSIST screening tools to identify symptoms consistent with OUD among incarcerated women in county jails. This study contributes to the existing literature because research on screening and assessment approaches for incarcerated women has been limited. The focus of the current study is to describe the screening procedures and study recruitment for a larger parent study focused on increasing treatment linkages. Study findings indicate a positive correlation between indicators of OUD using the two screening tools, as well as a high degree of correlation between street opioid misuse and other high-risk drug indicators (overdose and injection practices). These findings underscore the importance of outreach, screening, and intervention in real-world settings, including jails, in order to increase access to OUD treatment among this vulnerable sample of women.
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Affiliation(s)
- Michele Staton
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Martha Tillson
- Department of Sociology, College of Arts & Sciences, University of Kentucky, Lexington, KY, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
| | - Mary M. Levi
- Department of Psychology, College of Arts & Sciences, University of Kentucky, Lexington, KY, USA
| | - Matthew Webster
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Carrie Oser
- Faculty Affiliate, Center for Health Equity Transformation, Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
| | - Carl Leukefeld
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, USA
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Staton M, Tillson M, Levi MM, Dickson M, Webster M, Leukefeld C. Identifying and Treating Incarcerated Women Experiencing Substance Use Disorders: A Review. Subst Abuse Rehabil 2023; 14:131-145. [PMID: 38026785 PMCID: PMC10655602 DOI: 10.2147/sar.s409944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/02/2023] [Indexed: 12/01/2023] Open
Abstract
While research on substance use disorder (SUD) treatment among justice-involved populations has grown in recent years, the majority of corrections-based SUD studies have predominantly included incarcerated men or men on community supervision. This review 1) highlights special considerations for incarcerated women that may serve as facilitating factors or barriers to SUD treatment; 2) describes selected evidence-based practices for women along the cascade of care for SUD including screening and assessment, treatment and intervention strategies, and referral to services during community re-entry; and 3) discusses conclusions and implications for SUD treatment for incarcerated women.
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Affiliation(s)
- Michele Staton
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
| | - Martha Tillson
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
| | - Mary M Levi
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Megan Dickson
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
| | - Matt Webster
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
| | - Carl Leukefeld
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
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Hoover DB, Korthuis PT, Waddell EN, Foot C, Conway C, Crane HM, Friedmann PD, Go VF, Nance RM, Pho MT, Satcher MF, Sibley A, Westergaard RP, Young AM, Cook R. Recent Incarceration, Substance Use, Overdose, and Service Use Among People Who Use Drugs in Rural Communities. JAMA Netw Open 2023; 6:e2342222. [PMID: 37943559 PMCID: PMC10636631 DOI: 10.1001/jamanetworkopen.2023.42222] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/26/2023] [Indexed: 11/10/2023] Open
Abstract
Importance 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. Objective 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. Exposure 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. Main Outcomes and Measures The associations between PWUD who were recently incarcerated and main outcomes of treatment use and overdose were examined using logistic regression. Results 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). Conclusions and Relevance 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.
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Affiliation(s)
- Daniel B Hoover
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland
| | - P Todd Korthuis
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland
- Oregon Health & Science University-Portland State University School of Public Health, Portland
| | - Elizabeth Needham Waddell
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland
- Oregon Health & Science University-Portland State University School of Public Health, Portland
| | - Canyon Foot
- Division of General Internal Medicine, Oregon Health & Science University, Portland
| | | | - Heidi M Crane
- Department of Medicine, University of Washington, Seattle
| | - Peter D Friedmann
- Office of Research, University of Massachusetts Chan Medical School-Baystate, Baystate Health, Springfield
| | - Vivian F Go
- Department of Health Behavior, University of North Carolina-Chapel Hill, Chapel Hill
| | - Robin M Nance
- Department of Medicine, University of Washington, Seattle
| | - Mai T Pho
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago, Chicago, Illinois
| | - Milan F Satcher
- Department of Community & Family Medicine, Dartmouth Health and Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - Adams Sibley
- Department of Health Behavior, University of North Carolina-Chapel Hill, Chapel Hill
| | | | - April M Young
- College of Public Health, University of Kentucky, Lexington
| | - Ryan Cook
- Division of General Internal Medicine, Oregon Health & Science University, Portland
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Staton M, Pike E, Tillson M, Lofwall MR. Facilitating factors and barriers for use of medications to treat opioid use disorder (MOUD) among justice-involved individuals in rural Appalachia. JOURNAL OF COMMUNITY PSYCHOLOGY 2023:10.1002/jcop.23029. [PMID: 36930568 PMCID: PMC10505241 DOI: 10.1002/jcop.23029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
The purpose of this qualitative study is to assess facilitating factors and barriers for medications to treat opioid use disorder (MOUD) initiation among justice-involved individuals in one rural Appalachian community, as well as how those factors may differ across the three types of Food and Drug Administration (FDA) approved medications. Qualitative interviews were conducted with rural justice-involved individuals (N = 10) with a history of opioid use in the target community. Overall, participants demonstrated knowledge of the different types of MOUD and their pharmacological properties, but limited overall health literacy around opioid use disorder and MOUD treatment. Treatment access was hampered by transportation, time burdens, and costs. Findings call for research into improving health literacy education, training, and resources to decrease stigma and increase access to MOUD, particularly in light of the ongoing opioid crisis. State policies also need to increase access to all FDA medications among justice-involved individuals, as well as supporting a care continuum from facility entry, release, and community re-entry.
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Affiliation(s)
- Michele Staton
- Department of Behavioral Science, University of Kentucky College of Medicine, Medical Behavioral Science Building, Lexington, KY 40536-0086, USA
- Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Lexington, KY 40508, USA
| | - Erika Pike
- Department of Behavioral Science, University of Kentucky College of Medicine, Medical Behavioral Science Building, Lexington, KY 40536-0086, USA
| | - Martha Tillson
- Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Lexington, KY 40508, USA
- Department of Sociology, University of Kentucky College of Arts and Sciences, Lexington, KY 40506-0027, USA
| | - Michelle R. Lofwall
- Department of Behavioral Science, University of Kentucky College of Medicine, Medical Behavioral Science Building, Lexington, KY 40536-0086, USA
- Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Lexington, KY 40508, USA
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Feasibility of using Facebook for HIV prevention: Implications for translational research among justice-involved women who use drugs in rural Appalachia. J Clin Transl Sci 2023; 6:e127. [PMID: 36590363 PMCID: PMC9794968 DOI: 10.1017/cts.2022.497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 10/20/2022] [Accepted: 10/30/2022] [Indexed: 11/11/2022] Open
Abstract
Background Justice-involved women from rural Appalachia face significant barriers to the utilization of evidence-based HIV prevention interventions in spite of high rates of injection drug use and risky sexual practices. Adapting evidence-based practices to incorporate the cultural uniqueness of the target population is needed in order to advance translational and clinical science in this area. This study provides a descriptive overview of indicators of feasibility and acceptability of an adapted version of the National Institute on Drug Abuse Standard HIV prevention intervention for delivery using Facebook through a small randomized controlled pilot study with rural Appalachian women. Method Study methods include the random selection of rural Appalachian women from two local jails, screening for study eligibility, baseline data collection, random assignment to study interventions, and follow-up in the community three months post-release. Results Results indicate that the feasibility of the approach was supported through study enrollment of the target population who reported regular Facebook use and HIV risk behaviors including drug use and sex. Acceptability of the intervention was demonstrated through enrollment in the study intervention, engagement in the intervention through Facebook, and indicators of HIV/HCV knowledge. Conclusions Study findings contribute to the critical and unmet need to advance translational science on the delivery of evidence-based prevention interventions in real-world rural Appalachian settings to understudied, vulnerable individuals who are often overlooked in targeted prevention efforts.
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Smoyer AB, Pittman A, Borzillo P. Humans peeing: Justice-involved women's access to toilets in public spaces. PLoS One 2023; 18:e0282917. [PMID: 36897925 PMCID: PMC10004595 DOI: 10.1371/journal.pone.0282917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/24/2023] [Indexed: 03/11/2023] Open
Abstract
Justice-involved women face myriad challenges as they negotiate the terms of community supervision and manage the long-term implications and stigma of living with a criminal record. Major tasks that women juggle include securing safe, affordable housing, finding and retaining employment, accessing physical and mental health care (including substance use treatment), and handling relationships with family, friends, children, and intimate partners. In addition to these responsibilities, women must meet their basic physiological needs to eat, sleep, and use the toilet. Women's ability to safely meet their personal care needs may impact their capacity to manage their criminal-legal challenges. This study uses qualitative methods to understand justice-involved women's lived experiences related to urination. Specifically, the study reports on a thematic analysis of 8 focus groups conducted with justice-involved women (n = 58) and the results of a toilet audit conducted in the downtown areas of the small city in the United States where the focus group participants were living. Findings suggest that women had limited access to restrooms and reported urinating outside. Lack of restroom access impacted their engagement with social services support and employment and their ability to travel through public spaces. Women perceived their public toilet options as unsafe, increasing their sense of vulnerability and reinforcing the idea that they did not have full access to citizenship in the community because of their criminal-legal involvement. The exclusion and denial of women's humanity that is perpetuated by a lack of public toilet access impacts women's psychosocial outcomes. City governments, social service agencies, and employers are encouraged to consider how lack of toilet access may impact their public safety and criminal-legal objectives and expand opportunities for people to access safe restroom facilities.
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Affiliation(s)
- Amy B. Smoyer
- Department of Social Work, College of Health and Human Services, Southern Connecticut State University, New Haven, Connecticut, United States of America
- * E-mail:
| | - Adam Pittman
- Department of Sociology, College of Arts and Sciences, Southern Connecticut State University, New Haven, Connecticut, United States of America
| | - Peter Borzillo
- Department of Curriculum and Learning, College of Education, Southern Connecticut State University, New Haven, Connecticut, United States of America
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Validação de conteúdo do diagnóstico de enfermagem processos familiares interrompidos. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ao017166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Knittel AK, Ferguson EG, Balasubramanian V, Carda-Auten J, DiRosa E, Rosen DL. " We don't wanna birth it here": A qualitative study of Southern jail personnel approaches to pregnancy. WOMEN & CRIMINAL JUSTICE 2022; 33:349-362. [PMID: 37873022 PMCID: PMC10588771 DOI: 10.1080/08974454.2022.2040693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Each year, approximately 55,000 pregnant people are incarcerated in US jails. To learn about pregnancy and postpartum care in jails, we analyzed 34 qualitative interviews with jail personnel from facilities in five Southeastern US states. Themes included jail processes unique to pregnancy and burden on jails produced by liability and limited resources. Societal attitudes such as stigma, distrust of pregnant people, and a focus on fetal well-being were also important themes. Jail-community partnerships may mitigate the effects of scarce resources and improve jail perinatal care. Better community safety nets that decrease contact with jails are needed to improve pregnancy outcomes.
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Affiliation(s)
- Andrea K. Knittel
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Ella G. Ferguson
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Jessica Carda-Auten
- Division of Global health and Infectious Disease, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Elena DiRosa
- Division of Global health and Infectious Disease, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - David L. Rosen
- Division of Global health and Infectious Disease, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
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Medications for opioid use disorder during pregnancy: Access and continuity in a state women's prison facility, 2016-2019. Drug Alcohol Depend 2022; 232:109308. [PMID: 35074696 PMCID: PMC8946772 DOI: 10.1016/j.drugalcdep.2022.109308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although medications to treat opioid use disorder (MOUD) are the standard of care during pregnancy, there are many potential gaps in the cascade of care for pregnant people experiencing incarceration. METHODS We conducted a retrospective cohort study of pregnant people with opioid use disorder incarcerated in a Southeastern women's prison from 2016 to 2019. The primary outcomes were access to MOUD during incarceration and continuity in the community. We used descriptive statistics to summarize aspects of our sample and logistic regression to identify predictors of MOUD receipt during incarceration. RESULTS Of the 279 pregnant people with OUD included in the analysis, only 40.1% (n = 112) received MOUD during incarceration, including 67 (59.8%) who received methadone and 45 (40.1%) who received buprenorphine. Less than one-third of the participants were referred to a community MOUD provider (n = 83, 30%) on return to the community. Significant predictors of MOUD receipt included medium/close custody level during incarceration, incarceration during the latter portion of the study period, pre-incarceration heroin use, and receipt of pre-incarceration MOUD. CONCLUSIONS Although prisons can serve as an important site of retention in MOUD for some pregnant people, there were substantial gaps in initiation of MOUD and retention in MOUD among pregnant people with OUD imprisoned in the Southeast during the study period.
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Bunting AM, Dickson M, Staton M. Polysubstance use and re-incarceration in the 12-months after release from jail: a latent transition analysis of rural Appalachian women. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2022; 48:356-366. [PMID: 35130103 PMCID: PMC10119966 DOI: 10.1080/00952990.2021.1995402] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Rural areas have high rates of opioid and stimulant involved polysubstance use which are known to contribute to overdose. Justice-involved women are likely to have multiple substance use disorders and are particularly vulnerable in rural areas where treatment is limited. OBJECTIVES The research had three aims to (1) identify the patterns of polysubstance use of rural Appalachian justice-involved women, (2) examine how women's engagement in polysubstance use changed in the 12-months following initial release from jail, and (3) determine if women's changes in substance use patterns were associated with re-incarceration during the 12-months of post-release follow-up. METHODS A total of 339 women with recent substance use histories were randomly recruited from three rural jails. Latent transition analysis of women's substance use from baseline (in jail) to 6 and 12-months was examined, including the effect of re-incarceration on transitions (changes in substance use patterns). RESULTS Three latent classes were found: High Polysubstance/injection drug use (IDU) (36.3% baseline), Opioid/Benzo (Benzodiazepine) Involved Polysubstance Use (57.3% baseline), and Low Use (6.4% baseline). Polysubstance use classes were characterized by use of opioids and benzodiazepines; the High Polysubstance/IDU class was distinct in co-use and injection use of methamphetamine. Post-release, women transitioned to latent classes of reduced substance use and/or reduced injection drug use, particularly in the first six months. Women who were re-incarcerated during follow-up were likely to remain engaged in, or transition to, the High Polysubstance/IDU class (ORs: 3.14-46.56). CONCLUSION Justice-involved women in Appalachia reported risky polysubstance use. The first six-months post-release were a critical period for changes in substance use.
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Affiliation(s)
- Amanda M Bunting
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Megan Dickson
- Department of Behavioral Sciences, University of Kentucky, Lexington, KY, USA
| | - Michele Staton
- Department of Behavioral Sciences, University of Kentucky, Lexington, KY, USA
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Oser CB, Strickland J, Batty EJ, Pullen E, Staton M. The rural identity scale: Development and validation. J Rural Health 2022; 38:303-310. [PMID: 33666278 PMCID: PMC8418624 DOI: 10.1111/jrh.12563] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE The purpose of this study was to conduct a psychometric evaluation of a new 35-item survey developed in the United States to measure rural identity. METHODS Factor structure, reliability, convergent validity, and incremental validity of the Rural Identity Scale (RIS) were examined using two datasets. Study 1 examined RIS psychometric properties using survey data collected from substance use treatment counselors in a southeastern state (n = 145), while Study 2 used data collected from women incarcerated in rural jails (n = 400). FINDINGS A one-factor structure containing 15 items was identified in the RIS, with acceptable internal reliability (α = .72-.83). In Study 1, participants from rural counties had significantly higher RIS scores than their urban counterparts. In both studies, convergent validity was evaluated and the RIS scores were significantly associated with other measures relevant to identity and rurality at the bivariate level. Incremental validity was supported in multivariable models as the RIS scores were significantly and uniquely associated with primary rural place variables in each sample. CONCLUSIONS This study is an initial step toward a reliable, valid scale measuring rural identity. RIS may be especially beneficial to health research as a methodological tool that can contextualize health behaviors among rural populations and highlight potential interventions to promote health equity.
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Affiliation(s)
- Carrie B. Oser
- Department of Sociology, Center on Drug & Alcohol Research, Center for Health Equity Transformation, University of Kentucky, Lexington, Kentucky
| | - Justin Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Evan J. Batty
- Department of Sociology, University of Kentucky, Lexington, Kentucky
| | - Erin Pullen
- Indiana University Network Science Institute, Bloomington, Indiana
| | - Michele Staton
- Department of Behavioral Science, Center on Drug & Alcohol Research, University of Kentucky, Lexington, Kentucky
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Staton M, Dickson MF, Pike E, Surratt H, Young S. An Exploratory Examination of Social Media Use and Risky Sexual Practices: A Profile of Women in Rural Appalachia Who Use Drugs. AIDS Behav 2022; 26:2548-2558. [PMID: 35103889 PMCID: PMC8805664 DOI: 10.1007/s10461-022-03605-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 11/21/2022]
Abstract
HIV/HCV risk behavior among women who use drugs is often exacerbated within high risk networks. The use of social media platforms such as Facebook to identify sex partners within these high-risk networks has not been examined among rural Appalachian women who use drugs. This paper provides an exploratory examination of Facebook use to identify sex partners among rural Appalachian women who use drugs, as well as associated risky sexual practices. Rural Appalachian women were randomly selected from two rural jails, consented, screened for eligibility (including drug use), and interviewed prior to jail release. Findings indicated that using Facebook to meet sex partners was associated with exchanging sex for drugs or money and having a male casual partner during the same time frame. These study findings suggest that the use of social media for high-risk sexual practices may provide a valuable platform for intervention delivery, particularly in resource-deprived areas where formal prevention and treatment services are limited.
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Affiliation(s)
- Michele Staton
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA. .,Department of Behavioral Science, University of Kentucky College of Medicine, 1100 Veterans Dr., Lexington, KY, 40536, USA.
| | - Megan F. Dickson
- grid.266539.d0000 0004 1936 8438Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY USA ,grid.266539.d0000 0004 1936 8438Department of Behavioral Science, University of Kentucky College of Medicine, 1100 Veterans Dr., Lexington, KY 40536 USA
| | - Erika Pike
- grid.266539.d0000 0004 1936 8438Department of Behavioral Science, University of Kentucky College of Medicine, 1100 Veterans Dr., Lexington, KY 40536 USA
| | - Hilary Surratt
- grid.266539.d0000 0004 1936 8438Department of Behavioral Science, University of Kentucky College of Medicine, 1100 Veterans Dr., Lexington, KY 40536 USA
| | - Sean Young
- grid.266093.80000 0001 0668 7243Department of Emergency Medicine, School of Medicine, University of California, Irvine, Irvine, USA ,grid.266093.80000 0001 0668 7243Department of Informatics, School of Information and Computer Sciences, University of California, Irvine, Irvine, USA
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Victor GA, Staton M. Discriminant Function Analyses: Classifying Drugs/Violence Victimization Typologies Among Incarcerated Rural Women. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:889-911. [PMID: 32321355 DOI: 10.1177/0886260520913644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
This study examined the relationship between drug use and violence victimization among incarcerated women in Appalachian Kentucky. The purpose of this study was to test the utility of Goldstein's tripartite conceptual framework among rural incarcerated women, by examining whether distinct drugs/violence nexus groups could be classified based on psychopharmacological, economic-compulsive, and systemic factors. This study used secondary data from a National Institute on Drug Abuse (NIDA)-funded grant focused on risk reduction among high-risk incarcerated women in Appalachia (N = 400). Predicted drugs/violence groups were developed using a series of discriminant function analyses. The data yielded three statistically significant discriminant models. Findings of the classified groupings indicated support for three distinct drugs/violence victimization subgroups. The psychopharmacological group showed the greatest prevalence (n = 181; Wilks's λ = .389, F = 3.94, p < .001), followed by the economic-compulsive group (n = 77; Wilks's λ = .584, F = 11.86, p < .001) and systemic group (n = 55) significant (Wilks's λ = .994, F = 2.247, p < .035). To date, this is the first study to report a relationship between systemic violence victimization among rural communities. These findings could offer novel considerations for theory development and implications for clinical practice regarding the drug-related risks for violence victimization among rural incarcerated women.
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Silver IA, D’Amato C. The within-individual lagged effects of time spent incarcerated on substance use: a nationally representative longitudinal study from the United States. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.2006336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Ian A. Silver
- Law and Justice Department, Rowan University, Department of Law and Justice Studies 201 Mullica Hill Road, Glassboro New Jersey Glassboro, New Jersey, 8028 USA
- Corrections Institute, University of Cincinnati, Cincinnati, Ohio, USA
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Intimate Partner Violence and Structural Violence in the Lives of Incarcerated Women: A Mixed-Method Study in Rural New Mexico. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126185. [PMID: 34201033 PMCID: PMC8228824 DOI: 10.3390/ijerph18126185] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/15/2021] [Accepted: 06/01/2021] [Indexed: 12/14/2022]
Abstract
Intimate partner violence (IPV) is a common feature in the lives of incarcerated women returning to rural communities, enhancing their risk of mental ill-health, substance use, and recidivism. Women's experiences of IPV intersect with challenges across multiple social-ecological levels, including risky or criminalizing interpersonal relationships, geographic isolation, and persistent gender, racial, and economic inequities. We conducted quantitative surveys and qualitative interviews with 99 incarcerated women in New Mexico who were scheduled to return to micropolitan or non-core areas within 6 months. Quantitative and qualitative data were analyzed separately and then triangulated to identify convergences and divergences in data. The findings underscore how individual and interpersonal experiences of IPV, substance use, and psychological distress intersect with broad social inequities, such as poverty, lack of supportive resources, and reluctance to seek help due to experiences of discrimination. These results point to the need for a more proactive response to the mutually constitutive cycle of IPV, mental distress, incarceration, and structures of violence to improve reentry for women returning to rural communities. Policy and treatment must prioritize socioeconomic marginalization and expand community resources with attention to the needs of rural women of color.
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Knittel AK, Shook-Sa BE, Rudolph JE, Edmonds A, Ramirez C, Cohen MH, Adedimeji A, Taylor TN, Michel KG, Milam J, Cohen J, Donohue JD, Foster A, Fischl M, Konkle-Parker D, Adimora AA. Incidence and Prevalence of Incarceration in a Longitudinal Cohort of Women at Risk for Human Immunodeficiency Virus in the United States, 2007-2017. J Womens Health (Larchmt) 2021; 30:694-704. [PMID: 33544023 PMCID: PMC8112715 DOI: 10.1089/jwh.2020.8417] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: To estimate the incidence, prevalence, frequency, and duration of incarceration and to identify risk factors for incarceration among women at risk for human immunodeficiency virus (HIV) in the United States. Methods: During semiannual study visits in a multicenter cohort study, 970 HIV sero-negative participants at risk for HIV were asked about their own incarceration (10/2007-09/2017) and incarceration of sexual partners (10/2013-09/2017). We used descriptive statistics and multivariable log-binomial regression to identify baseline predictors of incident incarceration. Results: Median follow-up time across the 970 participants was 5.5 years (IQR 3.5-9.5). Nearly half (n = 453, 46.7%) of participants were incarcerated during or before the study, and the incarceration rate was 5.5 per 100 person-years. In multivariable models, incident incarceration was associated with prior incarceration (RR 5.20, 95% CI: 3.23-8.41) and noninjection drug use (RR 1.57, 95% CI: 1.10-2.25). Conclusions: Incarceration is common for women at risk for HIV. Prevention interventions that address the complex interplay of drug use, sex exchange, and housing instability for women who have experienced incarceration have the potential to reach an important group of U.S. women at risk of HIV infection.
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Affiliation(s)
- Andrea K. Knittel
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Bonnie E. Shook-Sa
- Department of Biostatistics and University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Jacqueline E. Rudolph
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Andrew Edmonds
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Catalina Ramirez
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | | | - Adebola Adedimeji
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Brooklyn, New York, USA
| | - Tonya N. Taylor
- Division of Infectious Disease, SUNY Downstate Medical Center, College of Medicine, Brooklyn, New York, USA
| | - Katherine G. Michel
- Department of Infectious Diseases, Georgetown University, Washington, District of Columbia, USA
| | - Joel Milam
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Jennifer Cohen
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jessica D. Donohue
- WIHS Data Management and Analysis Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Antonina Foster
- Division of Infectious Disease, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Margaret Fischl
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Deborah Konkle-Parker
- Division of Infectious Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Adaora A. Adimora
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
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Staton M, Knudsen HK, Walsh SL, Oser C, Pike E, Lofwall M. Adaptation of a standard extended-release naltrexone (XR-NTX) protocol for rural re-entering offenders with OUD. HEALTH & JUSTICE 2021; 9:4. [PMID: 33547578 PMCID: PMC7864137 DOI: 10.1186/s40352-021-00130-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/27/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Despite a growing body of empirical support for the effectiveness of extended-release naltrexone (XR-NTX) to reduce opioid relapse among people with opioid use disorder (OUD) transitioning from a correctional facility to the community, continuity of care following release remains challenging. This paper describes a research-based adaptation of a state's standard of care XR-NTX protocol using the ADAPT-ITT framework for delivery in a non-traditional, non-treatment, community criminal justice setting (P&P office), as well as the expansion of services by a local Federally Qualified Health Center (FQHC) provider who would, for the first time, be going to the jail and P&P office to provide XR-NTX and related treatment. METHOD The present study focuses on the first seven phases (Assessment through Training) of the ADAPT-ITT framework in the adaptation of the Department of Corrections (DOC) protocol in preparation for a pilot trial for induction in a rural jail and during the transition to a rural community. Expert clinical review and focus groups with key stakeholders in criminal justice supervision and the local providers in the FQHC informed the needed adaptations to the existing XR-NTX protocol for initiation at the jail and ongoing administrations in the community. RESULTS Findings from stakeholder focus groups, study team review, topical expert review, and a theater test suggested that there were critical adaptations needed in both content and context at the patient and clinic level. CONCLUSION Health and justice officials should consider the need to tailor and adapt evidence-based approaches for real-world locations that high-risk, justice-involved individuals visit in order to reduce barriers and increase access to critically needed treatment for OUD.
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Affiliation(s)
- Michele Staton
- Department of Behavioral Science, University of Kentucky College of Medicine, Medical Behavioral Science Building, Lexington, KY, 40536-0086, USA.
- Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Lexington, KY, 40508, USA.
| | - Hannah K Knudsen
- Department of Behavioral Science, University of Kentucky College of Medicine, Medical Behavioral Science Building, Lexington, KY, 40536-0086, USA
- Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Lexington, KY, 40508, USA
| | - Sharon L Walsh
- Department of Behavioral Science, University of Kentucky College of Medicine, Medical Behavioral Science Building, Lexington, KY, 40536-0086, USA
- Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Lexington, KY, 40508, USA
| | - Carrie Oser
- Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Lexington, KY, 40508, USA
- Department of Sociology, University of Kentucky College of Arts and Sciences, Lexington, KY, 40506-0027, USA
| | - Erika Pike
- Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Lexington, KY, 40508, USA
| | - Michelle Lofwall
- Department of Behavioral Science, University of Kentucky College of Medicine, Medical Behavioral Science Building, Lexington, KY, 40536-0086, USA
- Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Lexington, KY, 40508, USA
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Staton M, Tillson M, Webster JM. A Description of COVID-19 Lifestyle Restrictions Among a Sample of Rural Appalachian Women. JOURNAL OF APPALACHIAN HEALTH 2021; 3:4-17. [PMID: 35769440 PMCID: PMC9138730 DOI: 10.13023/jah.0301.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background COVID-19 has led to swift federal and state response to control virus transmission, which has resulted in unprecedented lifestyle changes for U.S. citizens including social distancing and isolation. Understanding the impact of COVID-19 lifestyle restrictions and related behavioral risks is important, particularly among individuals who may be more vulnerable (such as rural women with a history of substance use living in Appalachia). Purpose The overall purpose of this study was to better understand the perceptions of lifestyle changes due to COVID-19 restrictions among this vulnerable group. Methods The study included a mixed methods survey with a convenience sample of rural women (n=33) recruited through a closed, private Facebook group. Results Study findings indicated that COVID-19 restrictions related to limited social activities and interactions with family and friends had a significant impact on women. Implications Findings suggest that social isolation may have a number of unintended consequences for rural women, and implications for rural health practitioners are discussed.
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Staton M, Bunting AM, Pike E, Stevens-Watkins D. A Latent Profile Analysis of Rural Women who Use Drugs and Commit Crimes. JOURNAL OF RURAL SOCIAL SCIENCES 2021; 36:1. [PMID: 38501115 PMCID: PMC10948048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
The majority of rural Appalachian women in jail meet criteria for a drug use disorder and need treatment. Using a latent profile analysis of a random sample of rural women in Appalachian jails (N=400), the current study established groups of women based on criminal history, drug use in the commission of crimes, and role of the partner's drug use in the commission of crimes. Analysis found five distinct profiles of rural women based on involvement of criminal activities as a function of drug use severity. Results suggest that among criminally involved rural women, severity of drug use is a critical factor in the criminal career. Findings can be used to better inform treatment approaches and tailor treatment to meet the needs of this vulnerable population.
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Keesler JM, Brault E, Powell J, Johnston H. “If We Can Feel Like We Have Purpose and We Belong” - Exploring the Experiences of Drug-Involved Individuals in a Rural Jail. ALCOHOLISM TREATMENT QUARTERLY 2020. [DOI: 10.1080/07347324.2020.1765712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- John M. Keesler
- Indiana University Bloomington, School of Social Work, Bloomington, IN, USA
| | - Emily Brault
- Indiana University Bloomington, School of Social Work, Bloomington, IN, USA
| | - Joshua Powell
- Indiana University Bloomington, School of Social Work, Bloomington, IN, USA
| | - Helen Johnston
- Indiana University Bloomington, School of Social Work, Bloomington, IN, USA
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Webster JM, Tillson M, Dickson MF, Staton M. Impaired driving among rural female drug-involved offenders. TRAFFIC INJURY PREVENTION 2020; 21:513-520. [PMID: 32941075 PMCID: PMC7722978 DOI: 10.1080/15389588.2020.1810244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Very little is known about rural female impaired drivers despite disproportionate rates of impaired driving arrests and associated traffic fatalities in rural areas. The present study examined past-year impaired driving histories and impaired driving correlates in a sample of rural female drug-involved offenders. METHODS Female drug-involved offenders (N = 400) from 3 rural jails completed a confidential interview focused on substance use and related risk behaviors. After removing cases with missing data (n = 23), participants self-reporting past-year impaired driving (n = 254) were compared to those who did not (n = 123) on demographic characteristics, substance use, mental health, and criminal histories. Impaired drivers also reported the substances involved in their past-year impaired driving episodes. RESULTS A significantly higher percentage of impaired drivers reported past-year use of 8 of the 11 substances (including alcohol) examined when compared to other drug-involved offenders. Though symptoms of major depressive and posttraumatic stress disorders were similar, significantly more impaired drivers (49.6%) reported symptoms of generalized anxiety disorder than did other drug-involved offenders (35.0%). No differences in criminal histories were found. Nearly all (94.9%) impaired drivers reported driving under the influence of drugs in the past year; less than one-fourth reported driving under the influence of alcohol. Prescription opioids were the most prevalent substance type involved in impaired driving episodes (84.6%), followed by anti-anxiety medications (40.9%). Approximately one-third of impaired drivers reported driving under the influence of methamphetamine (33.9%), marijuana (31.5%), and alcohol (30.7%) in the past year. CONCLUSIONS Findings indicate that rural female impaired drivers may have more extensive substance use and mental health problems than other rural female drug-involved offenders. In addition, study results suggest that a recent history of impaired driving may serve as a marker for a more extensive substance use history. Other implications include that early identification of impaired drivers in at-risk groups may be an important opportunity to prevent future traffic injuries and fatalities.
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Affiliation(s)
- J. Matthew Webster
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY
| | - Martha Tillson
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY
| | - Megan F. Dickson
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY
| | - Michele Staton
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY
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Knittel AK, Zarnick S, Thorp JM, Amos E, Jones HE. Medications for opioid use disorder in pregnancy in a state women's prison facility. Drug Alcohol Depend 2020; 214:108159. [PMID: 32683223 PMCID: PMC7977476 DOI: 10.1016/j.drugalcdep.2020.108159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/16/2020] [Accepted: 06/21/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Medication for opioid use disorder (MOUD) improves both maternal and neonatal outcomes for pregnant women with opioid use disorder (OUD). Although correctional policies often state that incarcerated pregnant women with OUD should receive MOUD, implementation data is scant. Our aims were to 1) quantify the extent to which pregnant women in a Southeastern prison received MOUD during their incarceration; 2) to describe the medications and doses used during incarceration and frequency of MOUD referral after incarceration; and 3) identify associations between maternal characteristics and receipt of MOUD in order to identify points of intervention for clinical policy change. METHODS We conducted a retrospective chart review of pregnant women with OUD in a North Carolina state women's prison from 2016-2018. We collected MOUD, demographic, custody, pregnancy, and pre-incarceration substance use data. We used descriptive statistics, chi square tests, and logistic regression. RESULTS There were 179 pregnant women with OUD. During incarceration, 11.7 % received buprenorphine, 17.8 % methadone, 22.8 % oxycodone, and 47.8 % did not receive any opioid medications. Of those who received buprenorphine, methadone, and no MOUD, respectively, 65 %, 51.2 %, and 3.2 % were referred for community MOUD. Women were more likely to receive MOUD during incarceration if they had received MOUD pre-incarceration. CONCLUSIONS There was significant unmet need for MOUD and MOUD referral among pregnant women imprisoned in North Carolina from 2016-2018. Our findings suggest that the initial assessment for MOUD and referral to a community MOUD provider may represent opportunities to improve MOUD access for this population.
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Affiliation(s)
- Andrea K. Knittel
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | | | - John M. Thorp
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Elton Amos
- North Carolina Department of Public Safety, Raleigh, NC
| | - Hendree E. Jones
- UNC Horizons, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
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Smith KE, Archuleta A, Staton M, Winston E. Risk factors for heroin use following release from jail or prison in adults in a Central Appalachian state between 2012-2017. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2020; 46:485-497. [PMID: 33223579 PMCID: PMC7678949 DOI: 10.1080/00952990.2020.1725032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 02/05/2023]
Abstract
Background Corrections-involved adults with a history of opioid use disorder are at elevated risk of opioid overdose following release from correctional settings. Increased opioid prescribing restrictions and monitoring during a time when heroin is becoming cheaper and ubiquitous means that adults who misused prescription opioids prior to incarceration may be reentering communities at greater risk for heroin exposure and use. Objectives Determine risk factors of post-release heroin use among a sample of adults who participated in corrections-based drug treatment in Kentucky released between 2012 and 2017. Methods Survey data obtained as part of an ongoing evaluation of corrections-based drug treatment were examined. Results The final sample (N = 1,563) was majority male (80.9%). Nearly 11.0% reported past-year heroin use following their release. Depressive symptoms, polydrug use, and urban proximity were more common among participants reporting post-release heroin use. Heroin use 30 days prior to incarceration was associated with a 432.1% increase in odds of heroin use subsequent to incarceration. Post-release suicidal ideation increased odds of heroin use by 154.2%, whereas reporting satisfaction from social interactions decreased odds of use by nearly 60%. Post-release use of cocaine and diverted buprenorphine were associated with increased likelihood of heroin use during this time period, increasing odds by 469.1% and 265.9%, respectively. Residing in Central Appalachia subsequent to incarceration was associated with decreased likelihood of use. Conclusions In this sample, post-release heroin use was associated with concerning features, such as polydrug use, lack of social satisfaction, and suicidal ideation. These features can serve as clear targets for clinical intervention.
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Affiliation(s)
- Kirsten Elin Smith
- Center on Drug and Alcohol and Research, University of Kentucky, Lexington, KY, USA
- Kent School of Social Work, University of Louisville, Louisville, KY, USA
| | - Adrian Archuleta
- Kent School of Social Work, University of Louisville, Louisville, KY, USA
| | - Michele Staton
- Center on Drug and Alcohol and Research, University of Kentucky, Lexington, KY, USA
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
| | - Erin Winston
- Center on Drug and Alcohol and Research, University of Kentucky, Lexington, KY, USA
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Smith KE, Tillson MD, Staton M, Winston EM. Characterization of diverted buprenorphine use among adults entering corrections-based drug treatment in Kentucky. Drug Alcohol Depend 2020; 208:107837. [PMID: 31951906 PMCID: PMC7418075 DOI: 10.1016/j.drugalcdep.2020.107837] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 12/17/2019] [Accepted: 12/26/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND Illicit, medically unsupervised use of buprenorphine (i.e., "diverted use") among vulnerable and underserved populations, such as corrections-involved adults, remains underexplored. METHODS Survey data (2016-2017) collected as part of a clinical assessment of incarcerated adults entering corrections-based substance use treatment in Kentucky were analyzed. For years examined, 12,915 completed the survey. Removing cases for participants who did not reside in Kentucky for >6 months during the one-year pre-incarceration period (n = 908) resulted in a final sample size of 12,007. RESULTS Over a quarter of the sample reported past-year diverted buprenorphine use prior to incarceration and 21.8 % reported use during the 30-days prior to incarceration, using 6.5 months and 14.3 days on average, respectively. A greater proportion of participants who reported diverted buprenorphine use had previously been engaged with some substance use treatment (77.0 %) and reported greater perceived need for treatment (79.4 %) compared to those who did not report use. Use was more likely among participants who were younger, white, male, and who reported rural or Appalachian residence. Diverted buprenorphine users also evidenced extensive polydrug use and presented with greater substance use disorder severity. Non-medical prescription opioid, heroin, and diverted methadone use were associated with increased odds of diverted buprenorphine use while kratom was not. Diverted methadone use was associated with a 252.9 % increased likelihood of diverted buprenorphine use. CONCLUSIONS Diverted buprenorphine use among participants in this sample was associated with concerning high-risk behaviors and may indicate barriers to accessing opioid agonist therapies for corrections-involved Kentucky residents, particularly those in rural Appalachia.
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Affiliation(s)
- Kirsten E Smith
- Center on Drug and Alcohol and Research, University of Kentucky, Lexington, Kentucky 40508, United States; Kent School of Social Work, University of Louisville, Louisville, Kentucky, 40292, United States.
| | - Martha D Tillson
- Center on Drug and Alcohol and Research, University of Kentucky, Lexington, Kentucky 40508, United States; Department of Sociology, University of Kentucky, Lexington, Kentucky, 40508, United States
| | - Michele Staton
- Center on Drug and Alcohol and Research, University of Kentucky, Lexington, Kentucky 40508, United States; Department of Behavioral Science, University of Kentucky, Lexington, Kentucky, 40508, United States
| | - Erin M Winston
- Center on Drug and Alcohol and Research, University of Kentucky, Lexington, Kentucky 40508, United States
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Linn BK, Ely GE, Staton M. Latent Profiles of Health and Reproductive Risk and Protective Factors among Women in Appalachia. JOURNAL OF SOCIAL WORK PRACTICE IN THE ADDICTIONS 2020; 20:155-167. [PMID: 33209100 PMCID: PMC7668409 DOI: 10.1080/1533256x.2020.1748976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Women who use opiates and are involved in the criminal justice system in Appalachia may be prone to adverse health outcomes. In this study, we performed a latent class analysis of risk and protective factors on 400 drug-using women recruited from rural, Appalachian jails. A two-profile solution best fit the data. Both profiles evinced low levels of condom use, reproductive and physical health screens, and STD history. However, the primary substantive difference between the profiles was partner risk behavior: the higher risk class had main male partners with histories of injection drug use and incarceration. Results suggest that interventions need to be tailored to unique profiles of risk and protective factors, which should include taking partner risk into consideration.
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Affiliation(s)
- Braden K Linn
- Clinical and Research Institute on Addictions, University at Buffalo, The State University of New York, Buffalo, NY
| | - Gretchen E Ely
- School of Social Work, University at Buffalo, The State University of New York, Buffalo, NY
| | - Michele Staton
- University of Kentucky, College of Medicine, Medical Behavioral Science Building, Lexington, KY
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Staton M, Cramer J, Walker R, Snell-Rood C, Kheibari A. The importance of shared language in rural behavioral health interventions: An exploratory linguistic analysis. ACTA ACUST UNITED AC 2019; 43:138-149. [PMID: 33312331 DOI: 10.1037/rmh0000117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A focus on the use of shared language to enhance congruence in interventionist-client dialogue is missing from traditional research on evidence-based practices and rural behavioral health. This study incorporates qualitative interactional sociolinguistics, which includes discourse analysis (typically written or audio recordings of face-to-face encounters with 11 clients and a study interventionist), to describe those speech patterns in a broad sense (dialect), as well as more specific use of communicative strategies to increase parity in the interaction between a rural interventionist delivering an evidence-based practice in the context of a research study with rural women opioid users in a non-therapeutic context. Study findings indicated that in the context of delivering the intervention, use of a shared language, language pattern congruence, and communication styles can greatly augment the intent of the approach with vulnerable populations. In addition, other communicative strategies connected with traditional Appalachian values - such as religion, home, and family - were also important. This study makes an important contribution to behavioral health research and practice by understanding critical factors that may influence evidence-based practice delivery, particularly in real-world settings with vulnerable populations. These findings have important implications for the utilization of creative approaches to understand critical components of the clinical interaction as indicators of fidelity.
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Affiliation(s)
- Michele Staton
- University of Kentucky, College of Medicine, Department of Behavioral Science, 141 Medical Behavioral Science Building, Lexington, KY 40536
| | - Jennifer Cramer
- University of Kentucky, College of Arts & Sciences, Department of Linguistics, 1415 Patterson Office Tower, Lexington, KY 40506-0027
| | - Robert Walker
- University of Kentucky, College of Medicine, Center on Drug & Alcohol Research, 333 Waller Ave., Lexington, KY 40504
| | - Claire Snell-Rood
- Health and Social Behavior, School of Public Health, University of California, Berkeley
| | - Athena Kheibari
- Wayne State University, School of Social Work, 5447 Woodward Avenue, Detroit, MI. 48202
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Walker R, Staton M, Victor G, Smith K, Godlaski T. Fidelity in Evidence-based Practices in Jail Settings. FEDERAL PROBATION 2019; 83:45-51. [PMID: 34552275 PMCID: PMC8455082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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Staton M, Dickson M, Tillson M, Webster M, Leukefeld C. Staying Out: Reentry Protective Factors Among Rural Women Offenders. WOMEN & CRIMINAL JUSTICE 2019; 29:368-384. [PMID: 32855583 PMCID: PMC7449142 DOI: 10.1080/08974454.2019.1613284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The current study examines protective factors for women who transition from county jails to rural Appalachian communities, areas with limited health and behavioral health services. The study included drug-using women recruited from three jails in rural Appalachia and were followed 12-months post-release. Analyses focused on differences between women who remained in the community and those who returned to custody, as well as a multivariate model to determine protective factors for re-entry success. At the bivariate level, staying out of jail was associated with being older, having a job, not using drugs, stable housing, receiving health treatment, and having prosocial peers. In the multivariate model, the most robust predictors of staying out of jail were drug use abstinence, health care utilization, and prosocial peers. Most research on criminogenic needs associated with re-entry success have focused on men, and most focused on re-entry to urban communities where services and resources are more accessible. These findings have important implications for criminal justice systems to implement re-entry programs for women offenders during the transition to the community.
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Affiliation(s)
- Michele Staton
- University of Kentucky, College of Medicine, Department of Behavioral Science, Center on Drug & Alcohol Research, 141 Medical Behavioral Science Building, Lexington, KY 40536-0086
| | - Megan Dickson
- University of Kentucky, Center on Drug & Alcohol Research
| | - Martha Tillson
- University of Kentucky, Center on Drug & Alcohol Research
| | - Matthew Webster
- University of Kentucky, College of Medicine, Department of Behavioral Science
| | - Carl Leukefeld
- University of Kentucky, College of Medicine, Department of Behavioral Science
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Surratt HL, Staton M, Leukefeld CG, Oser CB, Webster JM. Patterns of buprenorphine use and risk for re-arrest among highly vulnerable opioid-involved women released from jails in rural Appalachia. J Addict Dis 2018; 37:1-4. [PMID: 30574844 DOI: 10.1080/10550887.2018.1531738] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Aims: Opioid use is common among correctional populations, yet few inmates receive treatment during incarceration or post-release, particularly in rural areas. This article examines associations of buprenorphine use, licit and illicit, health services use, and risk for re-arrest within 3 months of jail release among rural opioid-involved women. Methods: Women were randomly selected from three rural Appalachian jails. Those with moderate to severe opioid-involvement on the NM-ASSIST, and data on patterns of buprenorphine use (N = 188), were included in this analysis. Logistic regression analyses examined predictors of re-arrest within 3 months of release. Results: Median age was 32, all were White. At follow-up, 39 (22.7%) had been rearrested; 9 (5.2%) reported receiving MAT, all with buprenorphine. Significant risk factors for re-arrest included: number of days high, injection use, number of illicit buprenorphine days, and withdrawal symptoms in the follow-up period. The sole protective factor was having a regular source of healthcare at follow-up. Conclusions: Rural opioid-involved women released from jail are highly vulnerable to re-arrest, and lack access to supportive care systems for substance treatment. Innovations to integrate MAT into reentry to improve access is recommended.
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Staton M, Strickland JC, Webster JM, Leukefeld C, Oser C, Pike E. HIV Prevention in Rural Appalachian Jails: Implications for Re-entry Risk Reduction Among Women Who Use Drugs. AIDS Behav 2018; 22:4009-4018. [PMID: 29959722 PMCID: PMC6475200 DOI: 10.1007/s10461-018-2209-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Rural women are at risk for health consequences (such as HIV) associated with substance misuse, but targeted interventions are limited for this population. Jails provide an underutilized opportunity for outreach to high-risk women in rural Appalachian communities. Rural women were randomized to either the NIDA Standard education intervention (n = 201) or the NIDA Standard plus motivational interviewing (MI-HIV; n = 199) while in jail. Outcomes focused on HIV risk behaviors 3 months post-release from jail. Decreases in HIV risk behaviors were observed at follow-up across conditions. Although participants in the MI-HIV group showed reductions in outcomes compared to the NIDA Standard group (OR = 0.82-0.93), these estimates did not reach significance (p values > .57). HIV education interventions can be associated with risk-reduction behaviors. These findings support the need for increased access to prevention education in criminal justice venues, particularly in rural communities.
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Affiliation(s)
- Michele Staton
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, UK.
- Department of Behavioral Science, University of Kentucky Medical Center, Lexington, KY, 40536-0086, UK.
| | - Justin C Strickland
- Department of Psychology, College of Arts and Sciences, University of Kentucky, Lexington, KY, UK
| | - J Matthew Webster
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, UK
| | - Carl Leukefeld
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, UK
| | - Carrie Oser
- Department of Sociology, College of Arts and Sciences, University of Kentucky, Lexington, KY, UK
| | - Erika Pike
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, UK
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