{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T22:14:46Z","timestamp":1791756886717,"version":"4.3.4"},"reference-count":34,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,2,16]],"date-time":"2022-02-16T00:00:00Z","timestamp":1644969600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Center for Drug Use and HIV\/HCV Research (CDUHR)","award":["P30DA011041"],"award-info":[{"award-number":["P30DA011041"]}]},{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["K01DA053159"],"award-info":[{"award-number":["K01DA053159"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["P30DA01104"],"award-info":[{"award-number":["P30DA01104"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["T32 DA007233-31"],"award-info":[{"award-number":["T32 DA007233-31"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["4UH3DA044829-03"],"award-info":[{"award-number":["4UH3DA044829-03"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"name":"NIH Clinical and Translational Science Awards Program","award":["UL1TR001445"],"award-info":[{"award-number":["UL1TR001445"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: The COVID-19 pandemic has worsened the opioid overdose crisis in the US. Rural communities have been disproportionately affected by opioid use and people who use drugs in these settings may be acutely vulnerable to pandemic-related disruptions due to high rates of poverty, social isolation, and pervasive resource limitations. Methods: We performed a mixed-methods study to assess the impact of the pandemic in a convenience sample of people who use drugs in rural Illinois. We conducted 50 surveys capturing demographics, drug availability, drug use, sharing practices, and mental health symptoms. In total, 19 qualitative interviews were performed to further explore COVID-19 knowledge, impact on personal and community life, drug acquisition and use, overdose, and protective substance use adaptations. Results: Drug use increased during the pandemic, including the use of fentanyl products such as gel encapsulated \u201cbeans\u201d and \u201cbuttons\u201d. Disruptions in supply, including the decreased availability of heroin, increased methamphetamine costs and a concomitant rise in local methamphetamine production, and possible fentanyl contamination of methamphetamine was reported. Participants reported increased drug use alone, experience and\/or witness of overdose, depression, anxiety, and loneliness. Consistent access to harm reduction services, including naloxone and fentanyl test strips, was highlighted as a source of hope and community resiliency. Conclusions: The COVID-19 pandemic period was characterized by changing drug availability, increased overdose risk, and other drug-related harms faced by people who use drugs in rural areas. Our findings emphasize the importance of ensuring access to harm reduction services, including overdose prevention and drug checking for this vulnerable population.<\/jats:p>","DOI":"10.3390\/ijerph19042230","type":"journal-article","created":{"date-parts":[[2022,2,16]],"date-time":"2022-02-16T20:26:41Z","timestamp":1645043201000},"page":"2230","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":79,"title":["The Impact of the COVID-19 Pandemic on Drug Use Behaviors, Fentanyl Exposure, and Harm Reduction Service Support among People Who Use Drugs in Rural Settings"],"prefix":"10.3390","volume":"19","author":[{"given":"Rebecca S.","family":"Bolinski","sequence":"first","affiliation":[{"name":"Department of Sociology, Southern Illinois University, 475 Clocktower Drive, Room 323A, Carbondale, IL 62901, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzan","family":"Walters","sequence":"additional","affiliation":[{"name":"Center for Drug Use and HIV|HCV Research, School of Global Public Health, New York University, New York, NY 10003, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4096-6822","authenticated-orcid":false,"given":"Elizabeth","family":"Salisbury-Afshar","sequence":"additional","affiliation":[{"name":"Department of Family Medicine and Community Health, Madison School of Medicine and Public Health, University of Wisconsin, Madison, WI 53792, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence J.","family":"Ouellet","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Biostatistics\/COIP (MC 923), School of Public Health, University of Illinois Chicago, 1603 W. Taylor, Chicago, IL 60607, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wiley D.","family":"Jenkins","sequence":"additional","affiliation":[{"name":"Epidemiology and Biostatistics, Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, IL 62794, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9340-8635","authenticated-orcid":false,"given":"Ellen","family":"Almirol","sequence":"additional","affiliation":[{"name":"Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brent","family":"Van Ham","sequence":"additional","affiliation":[{"name":"Center for Rural Health and Social Service Development, Southern Illinois University School of Medicine, Carbondale, IL 62901, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Fletcher","sequence":"additional","affiliation":[{"name":"The Community Action Place, Inc., 1400 N. Wood Road Suite 7, Murphysboro, IL 62966, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago, Chicago, IL 60637, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A.","family":"Schneider","sequence":"additional","affiliation":[{"name":"Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago, Chicago, IL 60637, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"Ompad","sequence":"additional","affiliation":[{"name":"Center for Drug Use and HIV|HCV Research, School of Global Public Health, New York University, New York, NY 10003, USA"},{"name":"Department of Epidemiology, School of Global Public Health, New York University, New York, NY 10003, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mai T.","family":"Pho","sequence":"additional","affiliation":[{"name":"Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago, Chicago, IL 60637, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,2,16]]},"reference":[{"key":"ref_1","unstructured":"Ahmad, F.B., Rossen, L.M., and Sutton, P. 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Policy Rev."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/4\/2230\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:20:43Z","timestamp":1760134843000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/4\/2230"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,16]]},"references-count":34,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,2]]}},"alternative-id":["ijerph19042230"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19042230","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,16]]}}}