Evidence map›Paper›PMID 39580899›Full record

ArticleDrug and alcohol dependence2025

Rural houselessness among people who use drugs in the United States: Results from the National Rural Opioid Initiative.

April M Ballard, Zora Kesich, Heidi M Crane, Judith Feinberg, Peter D Friedmann, Vivian F Go, Wiley D Jenkins, P Todd Korthuis, William C Miller, Mai T Pho and 7 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Drug and alcohol dependence, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Observational
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors.

April M BallardSchool of Public Health, Georgia State University, 140 Decatur Street SE, Atlanta, GA 30303, USA; Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA. Electronic address: aballard11@gsu.edu.
Zora KesichRollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.
Heidi M CraneDepartment of Medicine, University of Washington, Seattle, WA, USA.
Judith FeinbergSchool of Medicine, West Virginia University, Morgantown, WV, USA.
Peter D FriedmannOffice of Research, University of Massachusetts Chan Medical School-Baystate, Springfield, MA, USA.
Vivian F GoGillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Wiley D JenkinsSchool of Medicine, Southern Illinois University, Springfield, IL, USA.
P Todd KorthuisDepartment of Medicine, Oregon Health & Science University, Portland, OR, USA.
William C MillerGillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Mai T PhoDepartment of Medicine, University of Chicago, Chicago, IL, USA.
David W SealTulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
Gordon S SmithSchool of Medicine, West Virginia University, Morgantown, WV, USA.
Thomas J StopkaDepartment of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.
Ryan P WestergaardSchool of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
William A ZuleRTI International, Research Triangle Park, NC, USA.
April M YoungCollege of Public Health, University of Kentucky, 111 Washington Avenue, Lexington, KY 40536, USA.
Hannah Lf CooperRollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.

Funding

Ending transmission of HIV, HCV, and STDs and overdose in rural communities of people who inject drugs (ETHIC)UH3DA044829 · NIDA · UNIVERSITY OF CHICAGO · PI JENKINS, WILEY, PHO, MAI TUYET · 2019 to 2022
$5.2M
Kentucky Communities and Researchers Engaging to Halt the Opioid Epidemic (CARE2HOPE)UH3DA044798 · NIDA · UNIVERSITY OF KENTUCKY · PI COOPER, HANNAH LF, YOUNG, APRIL MARIE · 2019 to 2022
$4.4M
Oregon HIV/Hepatitis and Opioid Prevention and Engagement (OR-HOPE) Study Cost ExtensionUH3DA044831 · NIDA · OREGON HEALTH & SCIENCE UNIVERSITY · PI KORTHUIS, PHILIP TODD · 2019 to 2022
$4.0M
Drug Injection Surveillance and Care Enhancement for Rural Northern New England (DISCERNNE)UH3DA044830 · NIDA · BAYSTATE MEDICAL CENTER, INC. · PI FRIEDMANN, PETER D, STOPKA, THOMAS J · 2019 to 2022
$3.9M
Rural Comorbidity and HIV consequences of Opioid use Research and Treatment Initiative (Rural cohort)U24DA048538 · NIDA · UNIVERSITY OF WASHINGTON · PI CRANE, HEIDI M., TSUI, JUDITH · 2019 to 2023
$3.7M
Community-based, client-centered prevention homes to address the rural opioid epidemicUH3DA044826 · NIDA · UNIVERSITY OF WISCONSIN-MADISON · PI SEAL, DAVID W, WESTERGAARD, RYAN PATRICK · 2019 to 2022
$2.6M
Learning from the COVID-19 pandemic to improve emergency management planning for harm reduction services in rural OhioUH3DA044822 · NIDA · OHIO STATE UNIVERSITY · PI GO, VIVIAN F., MILLER, WILLIAM C · 2019 to 2022
$2.5M
Mitigating the Outcomes Associated with the Injection Drug Use Epidemic in Southern AppalachiaUH3DA044823 · NIDA · RESEARCH TRIANGLE INSTITUTE · PI ZULE, WILLIAM A · 2019 to 2021
$2.4M
Drug Injection Surveillance and Care Enhancement for Rural Northern New England (DISCERNNE)UG3DA044830 · NIDA · BAYSTATE MEDICAL CENTER, INC. · PI FRIEDMANN, PETER D · 2017 to 2018
$1.6M
Community-based, client-centered prevention homes to address the rural opioid epidemicUG3DA044826 · NIDA · UNIVERSITY OF WISCONSIN-MADISON · PI SEAL, DAVID W, WESTERGAARD, RYAN PATRICK · 2017 to 2018
$1.4M
Kentucky Communities & Researchers Engaging to Halt the Opioid Epidemic-CARE2HOPEUG3DA044798 · NIDA · UNIVERSITY OF KENTUCKY · PI COOPER, HANNAH LF, YOUNG, APRIL MARIE · 2017 to 2018
$1.3M
Mitigating the Outcomes Associated with the Injection Drug Use Epidemic in Southern AppalachiaUG3DA044823 · NIDA · RESEARCH TRIANGLE INSTITUTE · PI ZULE, WILLIAM A · 2017 to 2018
$1.2M
NIDA NIH HHS U24 DA048538NIDA NIH HHS UG3 DA044798NIDA NIH HHS UG3 DA044822NIDA NIH HHS UG3 DA044823NIDA NIH HHS UG3 DA044825NIDA NIH HHS UG3 DA044826NIDA NIH HHS UG3 DA044829NIDA NIH HHS UG3 DA044830NIDA NIH HHS UG3 DA044831NIDA NIH HHS UH3 DA044798NIDA NIH HHS UH3 DA044822NIDA NIH HHS UH3 DA044823NIDA NIH HHS UH3 DA044826NIDA NIH HHS UH3 DA044829NIDA NIH HHS UH3 DA044830NIDA NIH HHS UH3 DA044831
6 · The paper itself

Abstract

backgroundOver the last two decades, houselessness and drug-related epidemics both have expanded from urban to rural regions across the United States (US). However, our understanding of the relationship between rural houselessness, drug use, and drug-related harms has not kept pace. The current study addresses this gap by describing houselessness among a large cohort of people who use drugs (PWUD) from rural communities across 10 states.

designPWUD were recruited using modified chain-referral sampling for a cross-sectional survey capturing houselessness in the prior six months, drug use, drug-related harms, stigma, health service access, and sociodemographic characteristics. Using bivariate logistic regressions, we assessed associations between houselessness and participant characteristics. We also compare site-specific houselessness prevalence to Housing and Urban Development Point-in-Time (PIT) estimates, which are based on counts of sheltered and unsheltered people experiencing houselessness on a single night.

resultsAmong 3000 PWUD, 53.7 % reported experiencing houselessness. Houselessness was associated with multiple drug-related behaviors that increase the risk of overdose and acquisition of bloodborne infections. Houselessness prevalence was comparable and exceeded PIT estimates for several sites, even though study participants constituted <1 % of each site's adult population and were restricted to PWUD.

conclusionsOur findings highlight that houselessness - historically considered an urban issue - is a significant public health concern for PWUD in rural areas. This demonstrates that addressing drug-related HIV, hepatitis C, and overdose epidemics, among others, in the rural US will require the provision of stable housing and harm reduction services as a pathway to treatment and recovery.

Indexed as

Rural PopulationAdultCross-Sectional StudiesDrug UsersFemaleHousingHumansMaleMiddle AgedOpioid-Related DisordersPrevalenceSubstance-Related DisordersUnited StatesYoung AdultHarm reductionHouselessnessRural areas

Identifiers

PMID39580899
PMCPMC11685035

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