People, places, and stigma: A qualitative study exploring the overdose risk environment in rural Kentucky
People, places, and stigma: A qualitative study exploring the overdose risk environment in rural Kentucky
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DOI：
10.1016/j.drugpo.2019.11.001
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发表时间：
2020-11-01
影响因子：
4.4
通讯作者：
Cooper, Hannah L. F.
中科院分区：
文献类型：
--
作者：
Fadanelli, Monica;Cloud, David H.;Cooper, Hannah L. F.
背景：尽管二十年来美国农村地区的用药过量率一直在上升，但人们对农村地区用药过量的风险环境知之甚少。这项定性研究探讨了美国阿片类药物流行的农村中心肯塔基州东部年轻人服用过量的风险环境。方法：通过社区外展招募参与者。资格标准包括居住在肯塔基州东部五个农村县之一；年龄在18-35岁之间；并在过去 30 天内使用阿片类药物来获得快感。半结构化访谈探讨了农村风险环境以及预防服药过量和因服药过量死亡的策略。访谈内容被逐字记录，并使用建构主义扎根理论方法进行分析。结果：在这个样本中（N = 19），参与者报告在一系列地点使用，包括家庭和户外环境；对社区耻辱和执法的担忧影响了参与者使用阿片类药物的环境，以及他们在这些环境中为防止用药过量和在用药过量后生存而采取的策略。近一半的参与者报告称，他们在“陷阱屋”或其他交易场所使用阿片类药物，通常是为了在购买毒品后逃避警察，并报告说，在场的其他人迫使他们比平时使用更多的药物。然而，如果在这种情况下发生服药过量，这些人可能会拒绝致电急救中心以保护自己免遭逮捕。户外环境特别容易吸毒过量并因吸毒过量而死亡。大多数参与者报告在户外使用阿片类药物，他们跳过了过量预防措施以降低被捕风险；他们担心，如果服药过量，没人会发现他们，而且手机覆盖范围太弱，无法呼叫急救人员。 结论：研究结果表明，通过缓和毒品战争和让执法部门参与保护阿片类药物使用者健康的举措，肯塔基州东部减少服药过量的举措将得到加强。
Background: Though overdose rates have been increasing in US rural areas for two decades, little is known about the rural risk environment for overdoses. This qualitative study explored the risk environment for overdoses among young adults in Eastern Kentucky, a rural epicenter of the US opioid epidemic.Methods: Participants were recruited via community-based outreach. Eligibility criteria included living in one of five rural Eastern Kentucky counties; being aged 18-35; and using opioids to get high in the past 30 days. Semi-structured interviews explored the rural risk environment, and strategies to prevent overdose and dying from an overdose. Interviews were transcribed verbatim and analyzed using constructivist grounded-theory methods.Results: In this sample (N = 19), participants reported using in a range of locations, including homes and outdoor settings; concerns about community stigma and law enforcement shaped the settings where participants used opioids and the strategies they deployed in these settings to prevent an overdose, and to survive an overdose. Almost half of participants reported using opioids in a "trap house" or other dealing locations, often to evade police after buying drugs, and reported that others present pressed them to use more than usual. If an overdose occurred in this setting, however, these same people might refuse to call EMS to protect themselves from arrest. Outdoor settings presented particular vulnerabilities to overdose and dying from an overdose. Most participants reported using opioids outdoors, where they skipped overdose prevention steps to reduce their risk of arrest; they worried that no one would find them if they overdosed, and that cell phone coverage would be too weak to summon EMS.Conclusion: Findings suggest that initiatives to reduce overdoses in Eastern Kentucky would be strengthened by de-escalating the War on Drugs and engaging law enforcement in initiatives to protect the health of people who use opioids.