Regular users of syringe exchanges who say they can decrease opioid use (and don't use meth) are more likely to get treatment

Counties in the study

One of the first studies to explore syringe-service programs in rural counties found that the participants who consistently used a syringe exchange and voiced high confidence in their ability to decrease substance use -- and did not first inject methamphetamine -- had significantly higher odds of participating in treatment, according to a new study.

"These findings support the notion that providing brief motivational and targeted, goal-setting interventions may improve treatment seeking and enrollment," says the study.

The study, published in The Journal of Rural Health, looked at 186 people who injected drugs (PWIDs) and used syringe-service programs, (SSPs) in two rural southeastern Kentucky counties, Knox and Owsley, and Clark, a rural-suburban county near Lexington. The study involved voluntary, on-site, face-to-face interviews about behaviors, injecting practices, syringe service program utilization and treatment services.

Data were collected through an ongoing National Institute on Drug Abuse-funded study designed to examine uptake of SSPs among PWIDs in Appalachian Kentucky.

Partly because it has so many small counties, Kentucky leads the nation in the number of syringe-exchange programs, which allow drug users to swap dirty needles for clean ones to thwart the spread of HIV and hepatitis C, as well as offering other "harm reduction" services.

Kentucky has 62 syringe-exchange programs operating in 55 counties. Four counties have approved a programs that are not yet operational.

Among the 186 participants in the study, 83 of them, or 44.6 percent, reported using a SSP more than six times over six months, which was considered "consistent use" for the purposes of the study.

Asked about the importance of quitting or reducing their substance use, 69.9% (130) of the participants said that was highly important; 17.7% (33) said it was of medium importance and 12.4% (23) said it was of low importance.

However, their confidence in their ability to quit or reduce their substance use was much lower, with 48.4%, (90) of them reporting high confidence; 28.5% (53) voicing medium confidence and 22.6% (42) expressing low confidence.

The researchers found that 21% (39) of the study participants had participated in treatment in the month before they were surveyed.

"Consistent SSP uptake, in terms of number of attended visits, was linked to significantly greater odds of current treatment participation," says the report. Later adding, "Participants reporting high confidence for decreasing substance use had significantly higher odds of treatment participation."

The study also found that participants in these rural exchanges had a higher proportion of newer clients and a higher proportion of repeat users, compared to some urban studies.

It found that more than one-third of the study participants had initiated SSP attendance in the month before the interview, while 28.5% of them had been utilizing the program for six months or longer. Further, 97% of the participants were repeat users.

"These findings indicate that rurally located SSPs are being utilized by high-risk PWID and represent a critical venue for the delivery of harm-reduction services in rural areas," says the report. "Attention to strengthening and resourcing these programs to further increase access (operating with extended hours or in mobile capacities) would appear to be warranted."

It also found that the SSP clients in the study had chronic, longstanding substance-use disorders, with both physical- and mental-health conditions that were significant.

"66% met criteria for past 90-day severe substance-use disorder, and 78% reported severe mental distress in the same time period, indicating that this is an important population to reach with expanded services," the report says.

It points out that nearly half, 47%, of the study participants were female, while urban studies typically have high percentages of males, as high as 70%.

The researchers said they couldn't pinpoint the reason why high confidence to change made consistent injectors of drugs more likely to get treatment. They write, "It is plausible that the association is a result of active, intentional treatment referrals from the SSP, an indirect effect of general social and recovery support available at the SSPs, or increased agency for behavior change that accrues from ongoing successful participation in the SSP. These findings are nevertheless promising and warrant additional investigation."

They also noted that because Kentucky has such high rates of methamphetamine use, it is of particular concern that the study found that people who inject meth first were less likely to be treated.

That "reflects a lack of treatment services designed for methamphetamine users, inadequate treatment capacity, as well as the lack of effective medication-assisted treatment [MAT] for methamphetamine use," the researchers write. "Improving formal access to opioid-focused MAT, and emphasizing combination behavioral and psychosocial therapies and adjuvants to address methamphetamine and other substance use, appears critical."

The study concluded, "Rurally located SSPs may play an important role in supporting confidence and motivation to change substance-use behaviors" and may be critical "for integration and expansion of prevention, health promotion, and treatment linkage services for this under-served population."

The study notes that the findings have several limitations, including that the interviews happened at a single time point and that the data was self-reported, which raises issues of recall and responses that reflect social desirability.