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Understanding the Individual and Social Network Characteristics of Opiate Users in Rural Pennsylvania

This pilot project will explore the individual, community, and peer network characteristics of those who use heroin and who misuse prescription pain relieves in Allegheny, Fayette, Greene, and Washington counties in Pennsylvania. Results from this project will help to understand more fully the mechanisms through which peer networks influence opiate abuse behaviors, including initiation, progression, frequency/severity of use, and entries into substance abuse treatment.

Understanding the Individual and Social Network Characteristics of Opiate Users in Rural Pennsylvania

Opiate abuse (nonmedical use of prescription pain relievers and heroin use) is a critical US public health and policy issue, especially in isolated and economically depressed rural areas where abuse and overdose mortality have skyrocketed in the past decade. Opiate abuse is particularly problematic because this may lead to an increase in the likelihood of future economic precariousness, relationship instability, poor health, and criminal justice involvement, resulting in major individual, family, and societal human and economic costs. Peer and family networks are known to be important mechanisms for initiation, progression, and duration of substance use, but there has been almost no research on the mechanisms through which peer networks influence opiate abuse behaviors, including initiation, progression, frequency/severity of use, and entries into substance abuse treatment. We propose to conduct exploratory analysis on the individual, community, and peer network characteristics of adults who use heroin and who misuse prescription pain relievers in four PA counties as part of a data collection pilot to inform the ‘preliminary analysis’ and ‘methods’ sections in proposals for external funding.

Project Team

Principal Investigators: Shannon Monnat; Assistant Professor of Rural Sociology, Demography, and Sociology; Department of Agricultural Economics, Sociology, and Education and The Population Research Institute; smm67@psu.edu;  Ashton Verdery, Assistant Professor of Sociology and Demography, Department of Sociology and Criminology, amv5430@psu.edu; 

Co-Investigators: Glenn Sterner, Post-Doctoral Scholar, Justice Center for Research, Department of Sociology and Criminology, ges5098@psu.edu; David Hunter, Professor and Head, Department of Statistics, dhunter@stats.psu.edu; Mark Feinberg, Research Professor, Department of Biobehavioral Health, mef11@psu.edu; Robert Turrisi, Professor, Department of Biobehavioral Health and Prevention Center, rjt13@psu.edu; Khary Rigg; Assistant Professor; Mental Health Law and Policy; University of South Florida; rig@usf.edu; Katherine McLean, Assistant Professor, Department of Administration of Justice, Penn State Greater Allegheny, kjm47@psu.edu

About the Project

  • Seed funding was provided by the Justice Center and the Social Science Research Institute at Penn Sate
  • Time line is August 1, 2016 – May 31, 2017
  • Pilot project for a National Institute of Drug Abuse Grant Proposal

Research Questions

  1. What are the characteristics of individuals, their communities, and their peer/family networks that are associated with opiate use, with a particular focus on current and recent (past-year) high-risk overdose behaviors (e.g., injecting; poly-substance use [including alcohol and other prescription medications]; use after periods of abstinence; use in isolation). Specific questions include: what precipitated opiate initiation; do individuals mostly use alone, with romantic partners/family members, or in larger groups; in what locations do individuals/groups most typically use; what is the frequency, type, and modes of use (e.g., oral, snorting, injecting); how do individuals gain access to opiates; how are opiates disseminated throughout the network; and do network members discuss experiences in treatment and/or overdose experiences?
  2. How does opiate abuse affect the composition of individuals’ personal networks, including: what proportion of friends are using prior to and at the time of initiation and at critical periods of escalation and/or desistance; how does the strength of relationships to users, non-users, and family members differ between individuals at different levels of abuse/addiction/dependence; and how do users with different durations of abuse differ in their position in the broader social network of users uncovered by the sampling method?

Project Details

The main objectives are to solidify local community partnerships; test the feasibility of our protocol, sampling, and data collection methods; collect pilot data; and conduct exploratory analyses on the individual, community, and peer network characteristics of adult opiate users in  Allegheny, Fayette, Greene, and Washington counties in PA. Specifically, we will:

  1. Solidify existing and develop new relationships with county drug abuse and prevention agencies and treatment providers in four PA counties who will serve as community partners and venues for sample recruitment and data collection. This includes forming an Advisory Committee to provide feedback on survey instruments and protocols and ways to disseminate our findings to ensure they reach appropriate stakeholders.
  2. Develop sampling and survey protocols and instruments to collect information about the individual and peer-network characteristics of opiate users.
  3. Collect survey data from a sample of 150 and interview data from opiate users using respondent-driven sampling, focusing on four adjacent southwestern PA counties.
  4. Analyze users’ individual, peer network, and community characteristics to identify their associations with current (past-month) and recent (past-year) opiate use behaviors, with a particular focus on high-risk overdose behaviors (e.g. injecting; poly-substance use; use after a long period of abstinence) and attempts at/experiences with treatment.
  5. Explore and test the feasibility of leveraging social network approaches for intervention and data collection innovations. We will pilot prospective data collection by using information respondents provide about their social network contacts to increase retention, with an aim of collecting data at 2 separate time points (within a 6 month period) from 20 respondents. We will also explore the feasibility of network approaches to intervention opportunities such as using peer network referrals to enroll high-risk respondents into HIV testing and counseling, drug treatment, and drug court diversion. The goal of this aim is exploratory rather than confirmatory, and we will focus on developing such interventions and assessing their feasibility with respondents and community partners (we will not actually conduct or test any interventions at this point).
  6. Develop a proposal for external funding to extend this research to a larger geographic area and test interventions identified in this pilot project.

Implications

This research has the potential to illuminate possible points of individual and peer network intervention in the trajectories from initiation to recreational use to opiate addiction for vulnerable individuals. The results could be disseminated to PA state Department of Health (which is currently in the process of designing a new prescription drug monitoring program), local physicians who prescribe opioids, and substance abuse treatment programs, including the ones from which we recruit respondents.

Related Presentations & Publications

Brainstorming Discussion of Methods for Sampling Rural Opiate Users
Monnat, S., Sterner, G., & Verdery, A.
Panel presentation: Penn State Mini-Conference on Social Networks, Infectious Disease, and Hidden Populations

Partners of Project

Justice Center for Research wordmark

Social Science Research Institute wordmark

Community Treatment Center Representatives

Cheryl Andrews
Executive Director, Washington County Drug and Alcohol Commission, Inc.
Washington, PA

Jana L. Kyle
Executive Director, Fayette County Drug and Alcohol Commission, Inc.
Uniontown, PA

Melissa Ferris
Assistant Director, Fayette County Drug and Alcohol Commission, Inc.
Uniontown, PA

Erica Usher
Prevention Supervisor, Fayette County Drug and Alcohol Commission, Inc.
Fayette County Health Center
Uniontown, PA

Brian Reese
Treatment Supervisor, Fayette County Drug and Alcohol Commission, Inc.
Fayette County Health Center
Uniontown, PA

Karen Bennett
Administrator, Greene County Human Services

Lori Gregan
Communities that Care Mobilizer, Greene County Human Services
Waynesburg, PA 

Alesha McGough
Clinical Supervisor of Drug & Alcohol Services, Mon-Yough Community Services
McKeesport, PA

Penn State Extension Representatives

Maureen Hogan
District Director, Allegheny County Extension
Assistant Director, Penn State Center Pittsburgh

Joseph C. Conklin
District 10 Director, Penn State Extension, Washington, Greene, and Fayette Counties
Washington, PA

Additional Partners

Stephanie Bradley
Managing Director, EPISCenter, The Prevention Research Center
University Park, PA

Barry Denk
Director, The Center for Rural Pennsylvania
Harrisburg, PA