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Article

The Impact of the COVID-19 Pandemic on Drug Use Behaviors, Fentanyl Exposure, and Harm Reduction Service Support among People Who Use Drugs in Rural Settings

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Department of Sociology, Southern Illinois University, 475 Clocktower Drive, Room 323A, Carbondale, IL 62901, USA
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Center for Drug Use and HIV|HCV Research, School of Global Public Health, New York University, New York, NY 10003, USA
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Department of Family Medicine and Community Health, Madison School of Medicine and Public Health, University of Wisconsin, Madison, WI 53792, USA
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Division of Epidemiology and Biostatistics/COIP (MC 923), School of Public Health, University of Illinois Chicago, 1603 W. Taylor, Chicago, IL 60607, USA
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Epidemiology and Biostatistics, Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, IL 62794, USA
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Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA
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Center for Rural Health and Social Service Development, Southern Illinois University School of Medicine, Carbondale, IL 62901, USA
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The Community Action Place, Inc., 1400 N. Wood Road Suite 7, Murphysboro, IL 62966, USA
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Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago, Chicago, IL 60637, USA
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Department of Epidemiology, School of Global Public Health, New York University, New York, NY 10003, USA
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Author to whom correspondence should be addressed.
Academic Editor: Paul B. Tchounwou
Int. J. Environ. Res. Public Health 2022, 19(4), 2230; https://doi.org/10.3390/ijerph19042230
Received: 5 January 2022 / Revised: 9 February 2022 / Accepted: 11 February 2022 / Published: 16 February 2022
Background: The COVID-19 pandemic has worsened the opioid overdose crisis in the US. Rural communities have been disproportionately affected by opioid use and people who use drugs in these settings may be acutely vulnerable to pandemic-related disruptions due to high rates of poverty, social isolation, and pervasive resource limitations. Methods: We performed a mixed-methods study to assess the impact of the pandemic in a convenience sample of people who use drugs in rural Illinois. We conducted 50 surveys capturing demographics, drug availability, drug use, sharing practices, and mental health symptoms. In total, 19 qualitative interviews were performed to further explore COVID-19 knowledge, impact on personal and community life, drug acquisition and use, overdose, and protective substance use adaptations. Results: Drug use increased during the pandemic, including the use of fentanyl products such as gel encapsulated “beans” and “buttons”. Disruptions in supply, including the decreased availability of heroin, increased methamphetamine costs and a concomitant rise in local methamphetamine production, and possible fentanyl contamination of methamphetamine was reported. Participants reported increased drug use alone, experience and/or witness of overdose, depression, anxiety, and loneliness. Consistent access to harm reduction services, including naloxone and fentanyl test strips, was highlighted as a source of hope and community resiliency. Conclusions: The COVID-19 pandemic period was characterized by changing drug availability, increased overdose risk, and other drug-related harms faced by people who use drugs in rural areas. Our findings emphasize the importance of ensuring access to harm reduction services, including overdose prevention and drug checking for this vulnerable population. View Full-Text
Keywords: fentanyl beans; fentanyl buttons; methamphetamine; COVID-19; rural; PWID; harm reduction fentanyl beans; fentanyl buttons; methamphetamine; COVID-19; rural; PWID; harm reduction
MDPI and ACS Style

Bolinski, R.S.; Walters, S.; Salisbury-Afshar, E.; Ouellet, L.J.; Jenkins, W.D.; Almirol, E.; Van Ham, B.; Fletcher, S.; Johnson, C.; Schneider, J.A.; Ompad, D.; Pho, M.T. The Impact of the COVID-19 Pandemic on Drug Use Behaviors, Fentanyl Exposure, and Harm Reduction Service Support among People Who Use Drugs in Rural Settings. Int. J. Environ. Res. Public Health 2022, 19, 2230. https://doi.org/10.3390/ijerph19042230

AMA Style

Bolinski RS, Walters S, Salisbury-Afshar E, Ouellet LJ, Jenkins WD, Almirol E, Van Ham B, Fletcher S, Johnson C, Schneider JA, Ompad D, Pho MT. The Impact of the COVID-19 Pandemic on Drug Use Behaviors, Fentanyl Exposure, and Harm Reduction Service Support among People Who Use Drugs in Rural Settings. International Journal of Environmental Research and Public Health. 2022; 19(4):2230. https://doi.org/10.3390/ijerph19042230

Chicago/Turabian Style

Bolinski, Rebecca S., Suzan Walters, Elizabeth Salisbury-Afshar, Lawrence J. Ouellet, Wiley D. Jenkins, Ellen Almirol, Brent Van Ham, Scott Fletcher, Christian Johnson, John A. Schneider, Danielle Ompad, and Mai T. Pho. 2022. "The Impact of the COVID-19 Pandemic on Drug Use Behaviors, Fentanyl Exposure, and Harm Reduction Service Support among People Who Use Drugs in Rural Settings" International Journal of Environmental Research and Public Health 19, no. 4: 2230. https://doi.org/10.3390/ijerph19042230

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