Introduction: Despite improved knowledge of the health care needs of formerly incarcerated women,... more Introduction: Despite improved knowledge of the health care needs of formerly incarcerated women, there exists a gap regarding the relationship between health, health care access, and relapse among rural women returning to the community during the opioid epidemic.
Purpose: With an emphasis on health care access, this study examined health-related factors associated with opioid relapse among women reentering the community in rural Appalachia.
Methods: As part of a larger study, 400 rural women reporting a history of substance use were recruited from three Appalachian jails in Kentucky. Analyses focused on participants reporting a history of illicit opioid use prior to incarceration, who had also completed follow-up interviews at 6-and 12-months post-release from jail.
Results: Fifty-five percent of participants reported relapse to opioids during the 12-month follow-up period. Compared to those who did not use opioids during this time, women who relapsed reported poorer mental and physical health, as well as encountered more barriers to needed health services. They were also more likely to report a usual source of care. Multivariate regression analyses reveal that, even when controlling for other known correlates of opioid use and relapse to any non-opioid drug during the follow-up period, the number of barriers to health service utilization was a significant predictor of opioid relapse.
Implications: Stakeholders should address the complex reentry needs of women who use opioids in rural Appalachia. This includes examining innovative approaches to reduce extensive barriers to quality health care utilization, such as implementing telehealth for opioid use treatment.
Background Individuals with substance use disorders (SUD), particularly opioid use disorder (OUD)... more Background Individuals with substance use disorders (SUD), particularly opioid use disorder (OUD), who are criminal justice-involved are a particularly vulnerable population that has been adversely affected by COVID-19 due to impacts of the pandemic on both the criminal justice and treatment systems. The manuscript presents qualitative data and findings exploring issues related to SUD/OUD treatment among individuals involved in the justice system and the impacts of COVID-19 on these service systems. Qualitative data were collected separately by teams from three different research hubs/sites in Illinois, Indiana, and Kentucky; at each hub, data were collected from justice system personnel (n = 17) and community-level SUD/OUD providers (n = 21). Codes from two hubs were reviewed and merged to develop the cross-hub coding list. The combined codes were used deductively to analyze the third hub‘s data, and higher-level themes were then developed across all the hubs’ data. Results Themes ...
Interpersonal relationships and social support are important factors in women’s successful reentr... more Interpersonal relationships and social support are important factors in women’s successful reentry from incarceration, but limited research has explored the role of women’s relationships to their communities during the reentry process. In the current study, women were recruited from three rural Appalachian jails, screened for high-risk behaviors (including drug use and unprotected sex), and interviewed at 12 months postrelease ( N = 339). Interviews included the Relational Health Indices–Community scale, a validated measure of women’s relationships in community contexts, with subscales for empowerment/zest, engagement, and authenticity. Women who were reincarcerated during the 12-month postrelease period (43.4%) were younger, less employed, more likely to have used illicit drugs, and reported lower-quality community relationships at 12-month follow-up. Multivariate logistic regression models indicated that the effect of community relationships may be driven by the engagement and emp...
Background: Opioid-related overdose deaths continue to rise with the ongoing opioid epidemic. In ... more Background: Opioid-related overdose deaths continue to rise with the ongoing opioid epidemic. In response, changes in the role of law enforcement officers have included being trained to administer naloxone to reverse overdoses and offering navigation and referrals to substance use treatment. Methods: This secondary data analysis includes qualitative data from law enforcement officers collected as part of a mixed-methods needs assessment from one Kentucky county. Law enforcement officers (n = 151) responded to a confidential, online survey using Qualtrics and a subsample also completed a qualitative interview (n = 6). Open-ended questions in the online survey and interviews included how the opioid epidemic has affected the individual's profession, specifically their role in reversing overdoses and providing referrals to individuals who misuse opioids. Results: Law enforcement officers surveyed indicated that they have expanded their professional roles to include providing naloxone to reverse opioid overdoses and referrals. While their specific roles and duties have changed to include naloxone administration to reverse opioid overdoses and providing referrals, officers felt that this was just part of their job in responding to the needs of the community. Officers reported that they have learned how to use (99%) and carry naloxone (87%) to reverse opioid related overdoses. The majority (92%) reported providing referrals (e.g., treatment and harm reduction resources) to individuals who misuse opioids. Conclusions: The opioid epidemic has changed the roles of law enforcement officers, including providing naloxone to reverse overdoses and referrals for treatment. Future research should continue to explore how substance misuse in the community changes the roles of law enforcement officers and how to best train and support officers as their roles evolve in response to these changes.
Research has documented the myriad benefits to public and individual health provided by syringe e... more Research has documented the myriad benefits to public and individual health provided by syringe exchange programs (SEPs), which allow persons who inject drugs access to sterile injection equipment. In 2015, Kentucky passed legislation that permitted public health departments to operate SEPs, but much remains unknown about knowledge and perceptions of the newly-implemented programs, particularly among individuals with histories of substance use. The present study therefore aimed to: 1) describe awareness of SEPs in Kentucky among participants of corrections-based substance abuse treatment programs, surveyed one year after their release into the community; 2) to determine if awareness of SEPs varies based on whether individuals live in counties with operational SEPs; 3) to describe perceptions of SEPs in Kentucky; and 4) to explore barriers and motivations for PWID to use SEPs. Results indicated that the majority of respondents had heard of SEPs in their area, and that individuals liv...
ABSTRACT:Background: COVID-19 has led to swift federal and state response to control virus transm... more ABSTRACT:Background: COVID-19 has led to swift federal and state response to control virus transmission, which has resulted in unprecedented lifestyle changes for U.S. citizens including social distancing and isolation. Understanding the impact of COVID-19 lifestyle restrictions and related behavioral risks is important, particularly among individuals who may be more vulnerable (such as rural women with a history of substance use living in Appalachia).Purpose: The overall purpose of this study was to better understand the perceptions of lifestyle changes due to COVID-19 restrictions among this vulnerable group.Methods: The study included a mixed methods survey with a convenience sample of rural women (n=33) recruited through a closed, private Facebook group.Results: Study findings indicated that COVID-19 restrictions related to limited social activities and interactions with family and friends had a significant impact on women.Implications: Findings suggest that social isolation may...
Research is limited on geographic differences in substance use risk factors among juvenile justic... more Research is limited on geographic differences in substance use risk factors among juvenile justice-involved girls. This secondary data analysis from one state juvenile justice system, collected as part of the NIH/NIDA funded JJTRIALS cooperative agreement, assessed criminogenic needs at intake for 160 girls from metropolitan and non-metropolitan counties. Although girls from different geographic areas did not differ significantly on key variables of interest, including substance use risk and related criminality variables, findings suggest that substance use risk is related to criminal history, substance-related offenses, and relationship problems among justice-involved girls. Implications include gender-specific juvenile justice programming and research.
Introduction: Despite improved knowledge of the health care needs of formerly incarcerated women,... more Introduction: Despite improved knowledge of the health care needs of formerly incarcerated women, there exists a gap regarding the relationship between health, health care access, and relapse among rural women returning to the community during the opioid epidemic. Purpose: With an emphasis on health care access, this study examined health-related factors associated with opioid relapse among women reentering the community in rural Appalachia. Methods: As part of a larger study, 400 rural women reporting a history of substance use were recruited from three Appalachian jails in Kentucky. Analyses focused on participants reporting a history of illicit opioid use prior to incarceration, who had also completed follow-up interviews at 6and 12-months postrelease from jail. Results: Fifty-five percent of participants reported relapse to opioids during the 12-month follow-up period. Compared to those who did not use opioids during this time, women who relapsed reported poorer mental and physi...
Objective Very little is known about rural female impaired drivers despite disproportionate rates... more Objective Very little is known about rural female impaired drivers despite disproportionate rates of impaired driving arrests and associated traffic fatalities in rural areas. The present study examined past-year impaired driving histories and impaired driving correlates in a sample of rural female drug-involved offenders. Methods Female drug-involved offenders (N = 400) from 3 rural jails completed a confidential interview focused on substance use and related risk behaviors. After removing cases with missing data (n = 23), participants self-reporting past-year impaired driving (n = 254) were compared to those who did not (n = 123) on demographic characteristics, substance use, mental health, and criminal histories. Impaired drivers also reported the substances involved in their past-year impaired driving episodes. Results A significantly higher percentage of impaired drivers reported past-year use of 8 of the 11 substances (including alcohol) examined when compared to other drug-in...
Background: Rising rates of intravenous drug use (IDU) in Appalachia have necessitated new approa... more Background: Rising rates of intravenous drug use (IDU) in Appalachia have necessitated new approaches to providing risk-reduction interventions in a manner which will be acceptable and accessible to specific at-risk populations—particularly those with limited access to traditional evidence-based interventions. Using the ADAPT-ITT framework, the overall goal of this study is to adapt an evidence-based HIV prevention intervention—the NIDA Standard—to meet the needs of rural drug-using women post-release from jail. Methods: Through a series of focus groups with rural incarcerated women, theater-testing with members of the target population, and iterative refinements with topical experts, we aimed to identify potential adaptations to content and context to improve the fit, feasibility, and acceptability of the NIDA Standard for this population using social media. Results: Study findings confirmed the need for a preventive risk-reduction intervention targeting this population post-releas...
Early onset of substance use has demonstrated a robust relationship with later severity of use, y... more Early onset of substance use has demonstrated a robust relationship with later severity of use, yet this relationship has been less examined in criminal justice contexts or examined differentially by gender. The present study utilized secondary data from a sample of offenders in one small Midwestern state entering corrections-based substance abuse treatment in prison, jail, or community settings to address these gaps in the literature. Findings indicated that age of regular cigarette use did not uniquely affect severity of illicit drug use in adulthood, defined as the frequency of use or endorsement of substance use disorder criteria. In comparison, ages of onset for alcohol and illicit drug use were significantly associated with multiple severity variables examined. Gender was not found to moderate these relationships. These findings emphasize that age of use onset for alcohol and illicit drugs can be valuable in identifying offenders at risk of severe substance use in adulthood.
Journal of health care for the poor and underserved, 2018
This study examines health care coverage and health care among rural, drug-involved female offend... more This study examines health care coverage and health care among rural, drug-involved female offenders under the Affordable Care Act (ACA) compared with pre-ACA and whether being insured is associated with having a usual source of care. This study involved random selection, screening, and face-to-face interviews with drug-using women in three rural Appalachian jails. Analyses focused on participants who had completed a three-month follow-up interview after release from jail (N=371). Analyses indicated that women released after ACA implementation were more likely than those released pre-implementation to be insured. A multivariate logistic regression model showed that being insured was significantly related to having a usual health care source during community re-entry. Results demonstrate the benefits of the ACA, signaling important implications for public health in rural communities and the criminal justice system, including targeting underserved groups during incarceration and provi...
The purpose of this paper is to examine drug use and incarceration history among rural Appalachia... more The purpose of this paper is to examine drug use and incarceration history among rural Appalachian women. This study involved random selection, screening, and interviews with rural women from local jails in Appalachia. Of the women randomly selected and screened, 97% met criteria for substance use intervention. Significant factors associated with incarceration history included age, education, custody status, and mental health. A significant interaction was observed between male sex partners and drug use on incarceration history. Study findings suggest that the drug/crime relationship among rural Appalachian women is associated with their high-risk home environment, partner relationships, and mental health. Specifically, in addition to drug use, factors such as family and child relationships, anxiety, victimization, and relationships with partners should also be considered in the trajectory of criminal careers among rural Appalachian women.
Introduction: Despite improved knowledge of the health care needs of formerly incarcerated women,... more Introduction: Despite improved knowledge of the health care needs of formerly incarcerated women, there exists a gap regarding the relationship between health, health care access, and relapse among rural women returning to the community during the opioid epidemic.
Purpose: With an emphasis on health care access, this study examined health-related factors associated with opioid relapse among women reentering the community in rural Appalachia.
Methods: As part of a larger study, 400 rural women reporting a history of substance use were recruited from three Appalachian jails in Kentucky. Analyses focused on participants reporting a history of illicit opioid use prior to incarceration, who had also completed follow-up interviews at 6-and 12-months post-release from jail.
Results: Fifty-five percent of participants reported relapse to opioids during the 12-month follow-up period. Compared to those who did not use opioids during this time, women who relapsed reported poorer mental and physical health, as well as encountered more barriers to needed health services. They were also more likely to report a usual source of care. Multivariate regression analyses reveal that, even when controlling for other known correlates of opioid use and relapse to any non-opioid drug during the follow-up period, the number of barriers to health service utilization was a significant predictor of opioid relapse.
Implications: Stakeholders should address the complex reentry needs of women who use opioids in rural Appalachia. This includes examining innovative approaches to reduce extensive barriers to quality health care utilization, such as implementing telehealth for opioid use treatment.
Background Individuals with substance use disorders (SUD), particularly opioid use disorder (OUD)... more Background Individuals with substance use disorders (SUD), particularly opioid use disorder (OUD), who are criminal justice-involved are a particularly vulnerable population that has been adversely affected by COVID-19 due to impacts of the pandemic on both the criminal justice and treatment systems. The manuscript presents qualitative data and findings exploring issues related to SUD/OUD treatment among individuals involved in the justice system and the impacts of COVID-19 on these service systems. Qualitative data were collected separately by teams from three different research hubs/sites in Illinois, Indiana, and Kentucky; at each hub, data were collected from justice system personnel (n = 17) and community-level SUD/OUD providers (n = 21). Codes from two hubs were reviewed and merged to develop the cross-hub coding list. The combined codes were used deductively to analyze the third hub‘s data, and higher-level themes were then developed across all the hubs’ data. Results Themes ...
Interpersonal relationships and social support are important factors in women’s successful reentr... more Interpersonal relationships and social support are important factors in women’s successful reentry from incarceration, but limited research has explored the role of women’s relationships to their communities during the reentry process. In the current study, women were recruited from three rural Appalachian jails, screened for high-risk behaviors (including drug use and unprotected sex), and interviewed at 12 months postrelease ( N = 339). Interviews included the Relational Health Indices–Community scale, a validated measure of women’s relationships in community contexts, with subscales for empowerment/zest, engagement, and authenticity. Women who were reincarcerated during the 12-month postrelease period (43.4%) were younger, less employed, more likely to have used illicit drugs, and reported lower-quality community relationships at 12-month follow-up. Multivariate logistic regression models indicated that the effect of community relationships may be driven by the engagement and emp...
Background: Opioid-related overdose deaths continue to rise with the ongoing opioid epidemic. In ... more Background: Opioid-related overdose deaths continue to rise with the ongoing opioid epidemic. In response, changes in the role of law enforcement officers have included being trained to administer naloxone to reverse overdoses and offering navigation and referrals to substance use treatment. Methods: This secondary data analysis includes qualitative data from law enforcement officers collected as part of a mixed-methods needs assessment from one Kentucky county. Law enforcement officers (n = 151) responded to a confidential, online survey using Qualtrics and a subsample also completed a qualitative interview (n = 6). Open-ended questions in the online survey and interviews included how the opioid epidemic has affected the individual's profession, specifically their role in reversing overdoses and providing referrals to individuals who misuse opioids. Results: Law enforcement officers surveyed indicated that they have expanded their professional roles to include providing naloxone to reverse opioid overdoses and referrals. While their specific roles and duties have changed to include naloxone administration to reverse opioid overdoses and providing referrals, officers felt that this was just part of their job in responding to the needs of the community. Officers reported that they have learned how to use (99%) and carry naloxone (87%) to reverse opioid related overdoses. The majority (92%) reported providing referrals (e.g., treatment and harm reduction resources) to individuals who misuse opioids. Conclusions: The opioid epidemic has changed the roles of law enforcement officers, including providing naloxone to reverse overdoses and referrals for treatment. Future research should continue to explore how substance misuse in the community changes the roles of law enforcement officers and how to best train and support officers as their roles evolve in response to these changes.
Research has documented the myriad benefits to public and individual health provided by syringe e... more Research has documented the myriad benefits to public and individual health provided by syringe exchange programs (SEPs), which allow persons who inject drugs access to sterile injection equipment. In 2015, Kentucky passed legislation that permitted public health departments to operate SEPs, but much remains unknown about knowledge and perceptions of the newly-implemented programs, particularly among individuals with histories of substance use. The present study therefore aimed to: 1) describe awareness of SEPs in Kentucky among participants of corrections-based substance abuse treatment programs, surveyed one year after their release into the community; 2) to determine if awareness of SEPs varies based on whether individuals live in counties with operational SEPs; 3) to describe perceptions of SEPs in Kentucky; and 4) to explore barriers and motivations for PWID to use SEPs. Results indicated that the majority of respondents had heard of SEPs in their area, and that individuals liv...
ABSTRACT:Background: COVID-19 has led to swift federal and state response to control virus transm... more ABSTRACT:Background: COVID-19 has led to swift federal and state response to control virus transmission, which has resulted in unprecedented lifestyle changes for U.S. citizens including social distancing and isolation. Understanding the impact of COVID-19 lifestyle restrictions and related behavioral risks is important, particularly among individuals who may be more vulnerable (such as rural women with a history of substance use living in Appalachia).Purpose: The overall purpose of this study was to better understand the perceptions of lifestyle changes due to COVID-19 restrictions among this vulnerable group.Methods: The study included a mixed methods survey with a convenience sample of rural women (n=33) recruited through a closed, private Facebook group.Results: Study findings indicated that COVID-19 restrictions related to limited social activities and interactions with family and friends had a significant impact on women.Implications: Findings suggest that social isolation may...
Research is limited on geographic differences in substance use risk factors among juvenile justic... more Research is limited on geographic differences in substance use risk factors among juvenile justice-involved girls. This secondary data analysis from one state juvenile justice system, collected as part of the NIH/NIDA funded JJTRIALS cooperative agreement, assessed criminogenic needs at intake for 160 girls from metropolitan and non-metropolitan counties. Although girls from different geographic areas did not differ significantly on key variables of interest, including substance use risk and related criminality variables, findings suggest that substance use risk is related to criminal history, substance-related offenses, and relationship problems among justice-involved girls. Implications include gender-specific juvenile justice programming and research.
Introduction: Despite improved knowledge of the health care needs of formerly incarcerated women,... more Introduction: Despite improved knowledge of the health care needs of formerly incarcerated women, there exists a gap regarding the relationship between health, health care access, and relapse among rural women returning to the community during the opioid epidemic. Purpose: With an emphasis on health care access, this study examined health-related factors associated with opioid relapse among women reentering the community in rural Appalachia. Methods: As part of a larger study, 400 rural women reporting a history of substance use were recruited from three Appalachian jails in Kentucky. Analyses focused on participants reporting a history of illicit opioid use prior to incarceration, who had also completed follow-up interviews at 6and 12-months postrelease from jail. Results: Fifty-five percent of participants reported relapse to opioids during the 12-month follow-up period. Compared to those who did not use opioids during this time, women who relapsed reported poorer mental and physi...
Objective Very little is known about rural female impaired drivers despite disproportionate rates... more Objective Very little is known about rural female impaired drivers despite disproportionate rates of impaired driving arrests and associated traffic fatalities in rural areas. The present study examined past-year impaired driving histories and impaired driving correlates in a sample of rural female drug-involved offenders. Methods Female drug-involved offenders (N = 400) from 3 rural jails completed a confidential interview focused on substance use and related risk behaviors. After removing cases with missing data (n = 23), participants self-reporting past-year impaired driving (n = 254) were compared to those who did not (n = 123) on demographic characteristics, substance use, mental health, and criminal histories. Impaired drivers also reported the substances involved in their past-year impaired driving episodes. Results A significantly higher percentage of impaired drivers reported past-year use of 8 of the 11 substances (including alcohol) examined when compared to other drug-in...
Background: Rising rates of intravenous drug use (IDU) in Appalachia have necessitated new approa... more Background: Rising rates of intravenous drug use (IDU) in Appalachia have necessitated new approaches to providing risk-reduction interventions in a manner which will be acceptable and accessible to specific at-risk populations—particularly those with limited access to traditional evidence-based interventions. Using the ADAPT-ITT framework, the overall goal of this study is to adapt an evidence-based HIV prevention intervention—the NIDA Standard—to meet the needs of rural drug-using women post-release from jail. Methods: Through a series of focus groups with rural incarcerated women, theater-testing with members of the target population, and iterative refinements with topical experts, we aimed to identify potential adaptations to content and context to improve the fit, feasibility, and acceptability of the NIDA Standard for this population using social media. Results: Study findings confirmed the need for a preventive risk-reduction intervention targeting this population post-releas...
Early onset of substance use has demonstrated a robust relationship with later severity of use, y... more Early onset of substance use has demonstrated a robust relationship with later severity of use, yet this relationship has been less examined in criminal justice contexts or examined differentially by gender. The present study utilized secondary data from a sample of offenders in one small Midwestern state entering corrections-based substance abuse treatment in prison, jail, or community settings to address these gaps in the literature. Findings indicated that age of regular cigarette use did not uniquely affect severity of illicit drug use in adulthood, defined as the frequency of use or endorsement of substance use disorder criteria. In comparison, ages of onset for alcohol and illicit drug use were significantly associated with multiple severity variables examined. Gender was not found to moderate these relationships. These findings emphasize that age of use onset for alcohol and illicit drugs can be valuable in identifying offenders at risk of severe substance use in adulthood.
Journal of health care for the poor and underserved, 2018
This study examines health care coverage and health care among rural, drug-involved female offend... more This study examines health care coverage and health care among rural, drug-involved female offenders under the Affordable Care Act (ACA) compared with pre-ACA and whether being insured is associated with having a usual source of care. This study involved random selection, screening, and face-to-face interviews with drug-using women in three rural Appalachian jails. Analyses focused on participants who had completed a three-month follow-up interview after release from jail (N=371). Analyses indicated that women released after ACA implementation were more likely than those released pre-implementation to be insured. A multivariate logistic regression model showed that being insured was significantly related to having a usual health care source during community re-entry. Results demonstrate the benefits of the ACA, signaling important implications for public health in rural communities and the criminal justice system, including targeting underserved groups during incarceration and provi...
The purpose of this paper is to examine drug use and incarceration history among rural Appalachia... more The purpose of this paper is to examine drug use and incarceration history among rural Appalachian women. This study involved random selection, screening, and interviews with rural women from local jails in Appalachia. Of the women randomly selected and screened, 97% met criteria for substance use intervention. Significant factors associated with incarceration history included age, education, custody status, and mental health. A significant interaction was observed between male sex partners and drug use on incarceration history. Study findings suggest that the drug/crime relationship among rural Appalachian women is associated with their high-risk home environment, partner relationships, and mental health. Specifically, in addition to drug use, factors such as family and child relationships, anxiety, victimization, and relationships with partners should also be considered in the trajectory of criminal careers among rural Appalachian women.
The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, Jan 7, 2017
Limited research has focused on correlates of injection drug use (IDU) among high-risk subgroups ... more Limited research has focused on correlates of injection drug use (IDU) among high-risk subgroups of drug users, particularly women, who may be at increased risk for transmission of infectious diseases such as HIV and Hepatitis C. The purpose of this study is to better understand the contextual and health correlates of IDU among women living in rural Appalachia by examining (1) differences between injectors and noninjectors, and (2) the unique correlates of recent IDU and past IDU. This study involved random selection, screening, and face-to-face interviews with 400 rural Appalachian women from jails in one state. Analyses included descriptive statistics, multinomial logistic regression, and stepwise regression to identify significant correlates of recent IDU and past IDU compared to never injecting. Findings indicated that 75.3% of this randomly selected sample reported lifetime injection of drugs. Contextual factors including drug use severity (RRR = 8.66, P < .001), more male s...
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Purpose: With an emphasis on health care access, this study examined health-related factors associated with opioid relapse among women reentering the community in rural Appalachia.
Methods: As part of a larger study, 400 rural women reporting a history of substance use were recruited from three Appalachian jails in Kentucky. Analyses focused on participants reporting a history of illicit opioid use prior to incarceration, who had also completed follow-up interviews at 6-and 12-months post-release from jail.
Results: Fifty-five percent of participants reported relapse to opioids during the 12-month follow-up period. Compared to those who did not use opioids during this time, women who relapsed reported poorer mental and physical health, as well as encountered more barriers to needed health services. They were also more likely to report a usual source of care. Multivariate regression analyses reveal that, even when controlling for other known correlates of opioid use and relapse to any non-opioid drug during the follow-up period, the number of barriers to health service utilization was a significant predictor of opioid relapse.
Implications: Stakeholders should address the complex reentry needs of women who use opioids in rural Appalachia. This includes examining innovative approaches to reduce extensive barriers to quality health care utilization, such as implementing telehealth for opioid use treatment.
Purpose: With an emphasis on health care access, this study examined health-related factors associated with opioid relapse among women reentering the community in rural Appalachia.
Methods: As part of a larger study, 400 rural women reporting a history of substance use were recruited from three Appalachian jails in Kentucky. Analyses focused on participants reporting a history of illicit opioid use prior to incarceration, who had also completed follow-up interviews at 6-and 12-months post-release from jail.
Results: Fifty-five percent of participants reported relapse to opioids during the 12-month follow-up period. Compared to those who did not use opioids during this time, women who relapsed reported poorer mental and physical health, as well as encountered more barriers to needed health services. They were also more likely to report a usual source of care. Multivariate regression analyses reveal that, even when controlling for other known correlates of opioid use and relapse to any non-opioid drug during the follow-up period, the number of barriers to health service utilization was a significant predictor of opioid relapse.
Implications: Stakeholders should address the complex reentry needs of women who use opioids in rural Appalachia. This includes examining innovative approaches to reduce extensive barriers to quality health care utilization, such as implementing telehealth for opioid use treatment.