Abstract
BACKGROUND: In many rural US Appalachian and Midwestern counties, stigma surrounding harm reduction interventions has led health professionals and policymakers to approach drug policy implementation with caution, fearing potential backlash from politically conservative communities. One concern is that the public's disapproval of harm-reduction policies may erode the public's trust in its government. METHODS: This study examined how the public's trust in the local government-as both self-reported and authority-assessed-is influenced by the perceived governmental support of comprehensive drug policies (i.e., inclusive of both drug treatment and harm reduction). Survey data gathered from 138 community authorities and 6,609 community residents from 13 Appalachian and Midwestern states between 2019 and 2023 were analyzed using a multiple regression approach. Furthermore, in an online experiment conducted in 2024, we experimentally simulated the role of authority vs. resident and manipulated the level of perceived governmental support for comprehensive drug policies (high vs. low) to assess their effects on trust and perceived governmental effort and feelings of optimism as possible mediators. RESULTS AND CONCLUSION: In both the field surveys and the experiment, trust was positively associated with perceptions of governmental support for comprehensive drug policies. In addition, authorities (both real and experimentally simulated roles) consistently assessed the public's trust in them to be higher than did residents. Both effects were mediated by participants' beliefs in the government's effort to reduce drug use problems and optimism that drug use issues could be improved.