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Our objective was to describe the barriers and facilitators to clinical trial participation among this understudied and underserved population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted semi\u2010structured in\u2010depth interviews among rural PWUD in Kentucky, Ohio, and Oregon. Using the Ickovics and Meisler framework, we classified factors associated with participation in clinical trials among rural PWUD into five categories: the individual, trial and intervention characteristics, participant\u2010trial staff relationship, clinical trial setting, and features of the disease. We used inductive qualitative analysis methods to identify salient themes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Thirty\u2010five rural participants (median age: 39, 51% men) completed in\u2010depth interviews. Facilitators for rural clinical trial participation were mainly situated within the individual, trial and intervention characteristics, and clinical trial setting. Individual characteristics, such as altruistic motivations to help their communities and peers, as well as trial and intervention characteristics like visit reminders and resource assistance, were the most frequently noted facilitators of clinical trial participation. In contrast, participation barriers were mainly related to participant\u2010trial staff relationships and disease features. Judgmental and untrustworthy trial staff, along with involvement in the criminal legal system, were obstacles to clinical trial participation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Individual, intrapersonal, and logistical factors described by rural PWUD must be addressed to enhance the participation and retention of this population in clinical trials. Successful clinical trial participation may contribute to equitable access to essential health services by PWUD in rural communities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jrh.70009","type":"journal-article","created":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T22:41:50Z","timestamp":1741732910000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["\u201cI'm tired of seeing my friends die\u201d: Barriers and facilitators to participating in clinical trials among rural people who use drugs in the United States"],"prefix":"10.1111","volume":"41","author":[{"given":"Kathryn E.","family":"Lancaster","sequence":"first","affiliation":[{"name":"Department of Implementation Science, Division of Public Health Sciences Wake Forest University School of Medicine  Winston\u2010Salem North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela T.","family":"Estadt","sequence":"additional","affiliation":[{"name":"Division of Epidemiology, College of Public Health Ohio State University  Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Madison N.","family":"Enderle","sequence":"additional","affiliation":[{"name":"Department of Implementation Science, Division of Public Health Sciences Wake Forest University School of Medicine  Winston\u2010Salem North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Todd P.","family":"Korthuis","sequence":"additional","affiliation":[{"name":"Department of Medicine, Section of Addiction Medicine Oregon Health &amp; Science University  Portland Oregon USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"April M.","family":"Young","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Environmental Health, College of Public Health University of Kentucky  Lexington Kentucky USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,3,5]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"Department of Health and Human Services.Determination That A Public Health Emergency Exists;2017."},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/00027162231154348"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2017.304132"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11904-018-0402-3"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1080\/10826084.2021.1887248"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2018.05.008"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2013.301709"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2018.04.011"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.23631"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.5888\/pcd20.220316"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.14299"},{"key":"e_1_2_8_13_1","volume-title":"Results from the 2023 National Survey on Drug Use and Health: Detailed tables","author":"Substance Abuse and Mental Health Services Administration","year":"2024"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1080\/09540121.2022.2141186"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jana.2012.08.007"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11904-018-0393-0"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2022.103930"},{"key":"e_1_2_8_18_1","unstructured":"Rural Health Information Hub.Healthcare Access in Rural Communities. 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