UNENDING MAZES: GENDERED INEQUALITIES, DRUG USE, AND STATE INTERVENTIONS IN RURAL APPALACHIA

Prescription opioids are associated with rising rates of overdose deaths and hepatitis C and HIV infection in the US, including in rural Central Appalachia. Yet there is a dearth of published ethnographic research examining rural opioid use. The aim of this dissertation is to document the gendered inequalities that situate women’s encounters with substance abuse treatment as well as additional state interventions targeted at women who use drugs. These results are based on ethnographic fieldwork completed from 2013 to 2016 and centered around one county seat in rural Central Appalachia. Data are ascertained through semi-structured interviews with women who have experiences with at least one of three types of substance abuse treatment offered in the area. Additional interviews were completed with program staff, institutional administrators, and community leaders. These data are supplemented with the collection of program documents, informal and follow-up communications, and participant observation in Eastern Kentucky communities, substance abuse treatment programs, and funding agencies. Social locations based on gender, income, access to quality health care, and place of residence contextualize women’s participation in illicit economies, entrance into and maintenance of drug use, particularly but not limited to opioids, and efforts to limit deleterious use. The state’s responses to drug use are manifested in these women’s lives through child protective services, incarceration, and substance abuse treatment. The sociopolitical and financial limitations on institutions often create instances in which policies exacerbate women’s marginalization. These policies are based on specific cultural understandings of women who use drugs, motherhood, Appalachia, and care. Women develop strategies, often based on care networks, to make it through these programs. Despite their navigations of marginalized and marginalizing programs, clients and institutional staff are materially and discursively constrained in their actions

Estimating Individual Syringe Coverage at Syringe Services Programs

The purpose of this guidance is to help syringe services programs (SSPs) in collecting and analyzing data on individual syringe coverage for their participants. Syringe coverage is an indicator that can help SSPs and other stakeholders estimate if people who inject drugs have enough syringes to reduce risks of infections and vein damage. This guidance is focused on calculating syringe coverage for the participants of one program and for sub-groups of participants of a program (e.g. participants who are unhoused). Health departments and researchers who work with SSPs could use this information to meaningfully engage with harm reduction staff to survey people who inject drugs and assess resource gaps

“We’re doing what we can”: Diverse voices aligning against substance abuse in Appalachian Kentucky

Prescription drugs are increasingly associated with overdose deaths, hepatitis C, and HIV in the US, including Appalachian Kentucky. Kentucky policy makers have responded to prescription drug and substance abuse with a number of initiatives that range from curbing access to drugs and criminalizing drug users to providing substance abuse treatment and additional services. Yet beyond simplified program evaluations, there are no studies that examine how these policies are translated into people’s lives. The aim of this presentation is to discuss how state level and local stakeholders, specifically those who work to provide substance abuse treatment and additional services, employees of the criminal justice system, and women in substance abuse treatment, differentially navigate the confines of state and federal drug policies to work against substance abuse in Appalachian Kentucky. These results are based on ethnographic fieldwork, primarily interviews and participant observation, completed from 2012 to 2015 in Kentucky. Key informants, including clinicians, researchers, and program administrators, who work in Appalachian Kentucky as well as women processing through substance abuse treatment in rural Appalachian Kentucky were interviewed. Participant observation was conducted in two rural Appalachian counties and at state meetings of organizations that operate in those counties. Although all study participants were working towards the same goals of decreasing the negative effects of substance abuse in their state, communities, or lives, participants employed numerous methods to attempt to reach these goals that reflect individual histories and experiences as well as how political and socioeconomic conditions constrain actions

Harm Reduction Workshop: Naloxone, Syringe Exchanges, and Social Justice

Most of us are well aware of the issues surrounding drug abuse in the US. Three of the five states with the highest drug overdose death rates in 2015 are in Appalachia, and seven Appalachian states experienced drug overdose death rate increases from 2014 to 2015. While some political responses to drug overdose have regressively further criminalized users, many Appalachian states and communities are seeking alternatives to criminalization. These harm reduction programs intended to lessen the negative consequences of drug use may come in various forms, including implementation of syringe exchange programs, increasing access to health care for viral and bacterial infections, and providing naloxone to first responders, individuals who use drugs, and their families. This workshop will begin by providing a half hour summary of these efforts and examples of successful programs in Appalachia. The last half hour of the workshop will focus on providing necessary skills to administer naloxone to someone who is overdosing. Fifteen minutes will be left to answer questions and discuss the issues at hand. Naloxone kits will be provided for everyone to take with them at the end of the workshop. Due to the nature of this workshop, participation will be limited to 20 attendees. If there is demand, we would be able to offer an additional workshop immediately before or after the proposed single workshop

Good Practices and Ethical Data Collection at Harm Reduction Programs: A Brief Summary

This guidance is for harm reduction programs and for funders and others who require data from programs. This is a brief summary of good and ethical data collection and data use practices in harm reduction programs. The guidance may help programs evaluate their data collection and use practices as well as help funders and others who require harm reduction data to review which data they require

Picketing, lanterns, and everyday resistance: Confronting gendered inequalities and state policies in Central Appalachia

Opiates are increasingly associated with overdose deaths, hepatitis C, and HIV in the US, including Central Appalachia. Appalachian service providers and community leaders connect opiate use with socioeconomic inequalities and barriers to appropriate health care. Policy makers have responded to substance abuse with a number of initiatives that range from criminalizing drug users to providing treatment and additional services. Yet there is a dearth of published studies on how these initiatives are translated into people’s lives and how local communities are responding to substance use. The aim of this presentation is to discuss how women in recovery and key informants who work closely with substance use navigate their communities’ political and economic environments as well as the confines of government drug policies. These results are based on ethnographic fieldwork completed from 2013 to 2016 in rural Central Appalachia. Women processing through substance abuse treatment and key informants, including clinicians, researchers, and program administrators, are interviewed. Both women in treatment and key informants utilize a variety of tools to confront and navigate the gendered inequalities, economic extremes, and state policies that situate women’s experiences with substance use and treatment. Participants are involved in political activism to increase economic opportunities, restore felon rights, and make harm reduction services for substance users available. Women and their supporters create spaces for those in recovery and misusers to vent their grief and frustrations and to find community. Participants also find less obvious methods of subverting socioeconomic inequalities and hiding themselves and their families from state programs that they view as intrusive and punitive

Cherokee and Latinx Futurities in WNC: Borderlands Theory, Birth Justice, and a Reorientation of Southern Appalachia

This paper foregrounds Borderlands theory to examine Latinx, Indigenous, and Latinx-Indigenous human locations in southern Appalachia. To be non-white in southern Appalachia is a continuity. It is also a contradiction. For thousands of years, the Eastern Band of Cherokee Indians have called the mountains of western North Carolina home. Southern Appalachia’s agriculture-based economy gestures to a past of enslaved labor (Black) and a present of migrant labor (Latinx). Yet in the collective American conscious Appalachia is white. This destructive misinformation has a utility: to claim a mythological white ancestor and thus naturalize claims to land. It also enforces borders of belonging. I use Gloria Anzaldúa’s Chicana feminist concept of the Borderland to examine how imagined social boundaries—those not defined by state-lines and those which are fuzzy and porous—fracture the human condition and inscribe an unstable relationship to place. Central to this study is the work of birthing. In western North Carolina, birth rates are uneven across racial populations with people of color having the highest mortalities. My research’s interlocutors are migrant farmworkers from Mexico, Central and South America as well as tribal members of the Eastern Band of Cherokee Indians (EBCI). These interlocutors seek to use doulas and midwifes with knowledge of their respective material and spiritual traditions for the healthy birth of their children. Through this study I ask, how do southern Appalachia’s Latinx, Indigenous, and Latinx-Indigenous peoples practice a politic of well-being to negotiate birth justice amid racial, cultural, and medical hostilities? How does birth transfer and transform the psychic life of borders? Furthermore, how can Anzaldúa’s framework spark a new ontology for Appalachia that disrupts an entrenched whiteness and pushes open the interstitial location of Latinx, Indigenous, and Latinx-Indigenous humans