ArticleThe International journal on drug policy2020
People, places, and stigma: A qualitative study exploring the overdose risk environment in rural Kentucky.
Article in The International journal on drug policy, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers.
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Who cites it
39 citing papers in PubMed, 70 citations in OpenAlex.
- History of Naloxone Possession Among Rural and Urban Individuals Participating in Prison-Based Treatment: An Observational Study.Substance use & addiction journal · 2026Observational
- "You've involved us knowing that we don't think about the law like you": a qualitative study on Supersavers' perspective of overdose engagement in Skåne county, South Sweden.Harm reduction journal · 2026Article
- Correlates of Rural Naloxone Possession Among People Who Use Drugs: A Multi-State Cross-Sectional Analysis.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2026Article
- Willingness to use a mobile syringe service program among people who inject drugs in rural Appalachia.Harm reduction journal · 2026Article
- Resilience to Stigma in Medical, Social, and Employment Contexts Among People Who Inject Drugs in Rural Ohio: Adapting the 10-Item Connor-Davidson Resilience Scale.AIDS and behavior · 2026Article
- Police officers' stigmatizing attitudes toward people who use drugs: implications for support of deflection.Harm reduction journal · 2026Article
- A descriptive analysis of rural-urban overdose experiences among incarcerated women with opioid use disorder.The American journal on addictions · 2025Article
- "I don't know how you can overdose smoking them:" Perceptions of overdose risks among persons who use illicit fentanyl-laced counterfeit pills.The International journal on drug policy · 2025Article
- Mapping the lived experience of rural substance use stigma: A conceptual framework of salient attitudes, beliefs, and behaviors in people who use drugs.Social science & medicine (1982) · 2025Article
- The Police Opioid Seizure Temporal Risk (POSTeR) model of increased exposure to fatal overdose.The International journal on drug policy · 2025Article
- Rural houselessness among people who use drugs in the United States: Results from the National Rural Opioid Initiative.Drug and alcohol dependence · 2025Article
- Implementation of an EMS-based naloxone distribution program: A qualitative evaluation.Journal of the American College of Emergency Physicians open · 2024Article
- "Expected to happen": perspectives on post-release overdose from recently incarcerated people with opioid use disorder.Harm reduction journal · 2024Article
- Overdose responses among rural people who use drugs: A multi-regional qualitative study.Harm reduction journal · 2024Article
- Missouri's Overdose Field Report: descriptive analysis, survival trends, and naloxone dosing patterns from a community-based survey tool, 2018-2022.The American journal of drug and alcohol abuse · 2024Article
- The paradox of high greenness and poor health in rural Central Appalachia.Environmental research · 2024Article
- The relationship between felt stigma and non-fatal overdose among rural people who use drugs.Harm reduction journal · 2024Article
- Identifying structural risk factors for overdose following incarceration: a concept mapping study.Health & justice · 2024Article
- Correlates of Recent HIV Testing Among People Who Inject Drugs in Rural Areas: A Multi-site Cross-Sectional Study, 2018-2020.AIDS and behavior · 2024Article
- Community-level Factors and their Associations with Changing Opioid Overdose Fatality Rates in Kentucky, 2019-2021.Journal of Appalachian health · 2024Article
Corrections and comments
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Authors and funding
7 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundThough 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.
methodsParticipants 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.
resultsIn 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.
conclusionFindings 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.
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Registered trials
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