Researchers from REACH Publish Systematic Review on Rural Injection Drug Use

The abuse of opioids has become one of the most defining crises of the current era in American history. Over the past couple of decades, the abuse of opioids and overdose deaths have risen dramatically—especially in economically struggling areas like Appalachia—and interventions targeted at reducing the opiate crisis have struggled to make a significant impact. Researchers at REACH have dedicated years of work to understanding how the opiate crisis, particularly injection drug use, manifests itself in communities in our backyard and beyond in order to analyze the crisis within social networks and scrutinize harm reduction policies.

Most recently, Luke Novack, Kimberly Gocchi Carrasco, Kimberly A. Tyler, Kirk Dombrowski, and Patrick Habecker of REACH lab published an article in the Journal of Drug Issues titled “Injection Opioid and Injection Methamphetamine Use in the Rural United States: A Systematic Review and Network Analysis.” To better understand these complex and compounding factors of rural drug use, REACH researchers set out to conduct a systematic review of the literature surrounding rural injection opioid and methamphetamine use. The unique factors of rural drug use are not only important to understand from a public health perspective but also because of their essential role in harm reduction strategies: injection is more often the preferred method of use in most rural communities and differences in culture and health infrastructure complicate intervention measures as well.

Following the PRISMA guidelines and protocol written by Hutton et al., the article synthesizes literature in human medical treatment and public health policy research related to rural injection opioid and methamphetamine use. Of the articles synthesized in the article, half of those (9) studied rural drug use in Appalachia, three in the United States as a whole, two in Missouri, two in North Carolina, one in a New York county, and in various rural communities throughout the U.S. While the intention of the literature review conducted by REACH researchers was meant to analyze rural injection drug use generally throughout the United States, doing so was complicated by the focus of current literature on the topic. Specifically, researchers found the lack of geographic diversity in current rural drug use literature troubling as it makes generalization and holistic understanding of the crisis hard to achieve. Head author Luke Novack was surprised by this lack of diversity, noticing that “all the studies were geographically very concentrated.”

Novack also noted that the literature was unified in other ways. The review’s results demonstrated that the majority of the authors represented in the literature review were affiliated with the University of Kentucky and the CDC. The articles reviewed also were unified methodologically. Novack noticed that “almost all of the quantitative papers relied on the same sampling method, respondent-driven sampling,” recognizing a sort of consensus in the field regarding the most effective and appropriate methodologies for studying rural injection drug use. In addition to the literature review, REACH authors also conducted a citation network analysis on the articles selected for review. The analysis demonstrated that the bulk of the literature cited two articles, Heckathorn (1997) and Heckathorn (2002), becoming foundational for the developing literature on the subject.

The results of the article also demonstrate that much of the research in the area has led to developing perspectives within the field regarding effective public health policies and interventions. Specifically, the literature widely emphasizes the importance of increased opioid surveillance, access to mental health and drug abuse treatment, naloxone interventions, access to HCV treatment and HCV/HIV preventative education, as well as the implementation of syringe exchange programs. Finally, researchers note the need for further research in mitigating the crisis. “Given the opioid epidemic and increasing methamphetamine use, further studies are needed in other rural parts of the country, particularly in the Northeast, Deep South, Midwest, Great Plains, and the West in order to create a generalized approach to the study of rural drug use, that also allows for regional specificity where necessary,” REACH researchers conclude. Noting the significant differences in rural drug use from community to community, year to year, Novack stated “Overall, I think that the topic is one that is continually evolving and that makes it both interesting and challenging to study.”

The lead author on the study, former REACH undergraduate researcher Luke Novack, is now pursuing a graduate education and continuing his research at the University of Colorado – Boulder. Regarding his time at REACH, Novack noted the formative nature of his participation in the research related to this article. “It was the first research project I had ever picked up and really taught me just how much work goes into getting an article from the initial inquiry to publication.”

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