Almost half of people who use drugs in rural areas were recently incarcerated, new research finds

New research finds that almost half of people who use illicit drugs in rural areas have been recently incarcerated.

Results from a survey of almost 3,000 people in eight rural areas nationwide who report using illicit drugs have been published in the journal JAMA Network Open. The study found that 42% had been incarcerated, either in prison or local jails, in the preceding six months.

The study was conducted by researchers at Oregon Health & Science University and institutions across 10 states.

The findings suggest a prime opportunity to tackle the nation's opioid crisis by expanding addiction treatment to people while they're incarcerated. Currently, access to proven therapies such as medication to treat addiction is limited or unavailable in many jails.

"You have a reachable time in jails, and most jails are not providing this kind of addiction care," said lead author Dan Hoover, M.D., assistant professor of medicine (general internal medicine and geriatrics) in the OHSU School of Medicine. "In a broader sense, our correctional institutions have a mandate to rehabilitate people who have entered the system—and treating addiction is a huge part of that."

Effective treatment during incarceration can benefit communities overall, Hoover noted.

He cited a study in Rhode Island that measured a 12% decrease in all overdoses statewide after the state implemented medication-assisted therapy in its prison system in 2016. Conversely, Hoover noted that forcing incarcerated individuals to go through withdrawal without treatment leaves them more vulnerable to resuming drug use, criminal conduct and a heightened risk of overdose once they're released.

"Many of these individuals are released back to the community within days," Hoover said. "Their health is community health. That time in jail is the reachable moment to begin their path to treatment and recovery."

Survey spans rural areas in 10 states

Researchers examined data from the Rural Opioid Initiative, a survey taken in eight rural U.S. regions from January 2018 to March 2020. The new study included 2,935 people who reported illicit drug use in the previous 30 days, inquiring about their substance use and treatment, and interactions with the criminal justice system.

The survey covered 65 rural counties across eight distinct regions spanning Oregon, Illinois, Wisconsin, North Carolina, Kentucky, West Virginia, Ohio, Massachusetts, New Hampshire and Vermont.

The study cited recent efforts in jurisdictions such as New Jersey and Seattle to develop pathways toward treatment and recovery for inmates while they're incarcerated and when they're released. For people with opioid use disorder, Food and Drug Administration-approved medications include methadone, buprenorphine and naltrexone, but the authors noted that those are rarely provided in American prison systems.

Oregon provides access to buprenorphine within the state prison system, but access remains spotty in local jails.

"Lack of criminal legal system funding apportioned for (substance use disorder, or SUD) treatment and lack of health insurance coverage during incarceration further contribute to poor SUD treatment access for this population," the authors write.

Data were collected and methods developed through the Rural Opioid Initiative, a multi-site study developed collaboratively by investigators at eight research institutions and the National Institute on Drug Abuse of the National Institutes of Health, the Appalachian Regional Commission, the Centers for Disease Control and Prevention and the Substance Abuse and Mental Health Services Administration.