ArticleDrug and alcohol dependence2020
Opioid initiation and injection transition in rural northern New England: A mixed-methods approach.
Article in Drug and alcohol dependence, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
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Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it, 23 citations in OpenAlex.
- Systematic review on intentional non-medical fentanyl use among people who use drugs.Frontiers in psychiatry · 2024Pooled it
- Mobile Telemedicine for Treating Chronic Hepatitis C Among Rural People Who Inject Drugs: A Randomized Clinical Trial.JAMA network open · 2026Trial
- Community coalition and key stakeholder perceptions of the community opioid epidemic before an intensive community-level intervention.Journal of substance abuse treatment · 2022Trial
- Transitions from first drug use to illicit opioid and injection drug use in a multisite rural U.S. cohort of people who use drugs.Harm reduction journal · 2026Article
- Medications for Opioid Use Disorder Among Transition Age Youth Compared to Adults 26 or Older in Rural Settings.JAACAP open · 2024Article
- Patients' perspectives on buprenorphine subcutaneous implant: a case series.Journal of medical case reports · 2024Article
- Frame Shift: Focusing on Harm Reduction and Shared Decision Making for People Who Use Drugs Hospitalized With Infections.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2024Article
- Association of spatial proximity to fixed-site syringe services programs with HCV serostatus and injection equipment sharing practices among people who inject drugs in rural New England, United States.Harm reduction journal · 2024Article
- HCV serostatus and injection sharing practices among those who obtain syringes from pharmacies and directly and indirectly from syringe services programs in rural New England.Addiction science & clinical practice · 2023Article
- The experience of buprenorphine implant in patients with opioid use disorder: a series of narrative interviews.Frontiers in psychiatry · 2023Article
- "I've been to more of my friends' funerals than I've been to my friends' weddings": Witnessing and responding to overdose in rural Northern New England.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2023Article
- The effects of opioid policy changes on transitions from prescription opioids to heroin, fentanyl and injection drug use: a qualitative analysis.Substance abuse treatment, prevention, and policy · 2022Article
- Effects of State Opioid Prescribing Laws on Use of Opioid and Other Pain Treatments Among Commercially Insured U.S. Adults.Annals of internal medicine · 2022Article
- Association Between Prescription Opioid Therapy for Noncancer Pain and Hepatitis C Virus Seroconversion.JAMA network open · 2022Article
- Prescription opioid treatment for non-cancer pain and initiation of injection drug use: large retrospective cohort study.BMJ (Clinical research ed.) · 2021Article
- Opioid use disorder: a neglected human immunodeficiency virus risk in American adolescents.AIDS (London, England) · 2021Article
- Kratom Use in the US: Both a Regional Phenomenon and a White Middle-Class Phenomenon? Evidence From NSDUH 2019 and an Online Convenience Sample.Frontiers in pharmacology · 2021Article
Corrections and comments
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Authors and funding
6 authors at 5 institutions in 1 country.
Funding
Abstract
backgroundIn rural northern New England, located in the northeastern United States, the overdose epidemic has accelerated with the introduction of fentanyl. Opioid initiation and transition to opioid injection have been studied in urban settings. Little is known about opioid initiation and transition to injection drug use in rural northern New England.
methodsThis mixed-methods study characterized opioid use and drug injection in 11 rural counties in Massachusetts, Vermont, and New Hampshire between 2018 and 2019. People who use drugs completed audio computer-assisted self-interview surveys on substance use and risk behaviors (n = 589) and shared personal narratives through in-depth interviews (n = 22). The objective of the current study is to describe initiation of opioid use and drug injection in rural northern New England.
resultsMedian age of first injection was 22 years (interquartile range 18-28 years). Key themes from in-depth interviews that led to initiating drug injection included normalization of drug use in families and communities, experiencing trauma, and abrupt discontinuation of an opioid prescription. Other factors that led to a transition to injecting included lower cost, increased effect/ rush, greater availability of heroin/ fentanyl, and faster relief of withdrawal symptoms with injection.
conclusionsTrauma, normalization of drug use, over-prescribing of opioids, and abrupt discontinuation challenge people who use drugs in rural northern New England communities. Inadequate opioid tapering may increase transition to non-prescribed drug use. The extent and severity of traumatic experiences described highlights the importance of enhancing trauma-informed care in rural areas.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.