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Families of people with opioid use disorder (OUD) often provide informal care, serving an integral supportive role in the healthcare system. Yet these family members are often overlooked as a population under strain and in need of support themselves. In this study, we examine the stress faced by family members of persons with OUD in Massachusetts, USA, through semi-structured qualitative interviews (N = 22, April–July 2018). Data revealed that family members experience shame around OUD and live in a state of overwhelming worry about opioid overdose and that this fear permeates all aspects of their lives, impacting their health, relationships, employment, and finances. Effective coping and social support mitigated some of these challenges. This study fills a gap in the research by examining the challenges distinct to supporting a loved one with OUD – largely stress and trauma related to opioid overdose. [ABSTRACT FROM AUTHOR]

Background and Aims: Injection drug use has increased in non‐urban communities in the United States where sterile syringe access is limited. This study aimed to characterize how people who inject drugs in a predominantly rural state navigate syringe scarcity. Design Qualitative study. Setting New Hampshire (NH), USA. At the time of our study, syringe services programs were illegal in NH but pharmacies could sell ≤ 10 syringes without prescription. Participants/Cases: Twenty people aged ≥ 18 years who injected at least once in the past 30 days were recruited through provider referral, street‐based recruitment and snowball sampling. Measurements Semi‐structured interview guide. Verbatim transcripts were coded based on interview guide constructs and emergent themes. Analysis focused on pharmacy syringe access, unofficial syringe sources and related impacts on syringe sharing and reuse Findings Participants could identify no local pharmacies that sold syringes without prescription. Pharmacy purchase in neighboring counties, or across state lines, required private transportation and this, along with purchaser identification requirements, presented substantial access barriers. Interstate travel also exposed participants to vigilant policing of interstate highways and potential criminal justice involvement. Many participants thus resorted to informal syringe sources closer to home including purchasing syringes on the street, using discarded syringes, breaking into biohazard containers and constructing improvised syringes out of salvaged syringe parts, metals and plastics. Repeated re‐use of syringes until they were no longer operational was common. Overall, syringe scarcity gave participants few options but to engage in syringe sharing and re‐use, putting them at risk of serious injection‐related infections. Conclusions: Limited sterile syringe access contributes to an environment in which people who inject drugs report that they are less able to refrain from risky injection practices. [ABSTRACT FROM AUTHOR]