Impacts of the COVID-19 Pandemic on a Rural Opioid Support Services Program

Abstract

During 2020, Kentucky saw the third highest increase in overdose deaths in the U.S. Employment issues, inadequate housing, transportation problems, and childcare needs present barriers to accessing treatment in rural areas. These barriers and others (e.g., technology) arose during the pandemic negatively affecting individuals in recovery and service providers as they adjusted services to provide primarily telehealth and remote services. This study examines the impact of COVID-19 in its early stages on an opioid use disorder (OUD) support services program in a nonprofit located in rural eastern Kentucky, part of the central Appalachia region. A qualitative design was applied, employing semi-structured interviews in early fall 2020. Participants were associated with one OUD support services program, including service recipients, program coordinators, and business vendors. Guided by the Social Determinants of Health framework, two-cycle coding–descriptive coding and pattern coding–was utilized. Codes were sorted into three patterns: changes to daily life; financial impacts; and service access and provision. Overall, early stages of COVID-19 brought increased stress for individuals in recovery, as they were taking on more responsibility and navigating a changing environment. Coordinators were under pressure to provide services in a safe, timely manner. Vendors vocalized their struggles and successes related to finances. These findings can help organizations make realistic adjustments and policymakers set reasonable expectations and consider additional financial support.

Barriers to utilizing substance use disorder treatment and harm reduction services in Appalachia.

“…A lack of housing and safety for PWUD makes it difficult to safeguard belongings, including resources such as medication or syringes provided by treatment programs (Allen et al, 2020). Inconsistent cell phone service in rural and remote areas of Appalachia and the difficulty of maintaining a working phone create barriers to communication necessary for treatment programs to provide services—especially given the increased use of telehealth in recent years (Allen et al, 2020; Lilly et al, 2019; Walters et al, 2022). Lack of childcare is also noted as a primary barrier to treatment, making it difficult for caretakers to attend treatment without bringing children with them or leaving their children unattended (Buer et al, 2016; Lilly et al, 2019).…”

Understanding and learning from rural drug service adaptations to opioid substitution therapy during the COVID-19 pandemic: the What C-OST? study

“…In the US, the lack of mobile phone coverage in rural areas was a particular barrier to telemedicine ( 12 ). Further work from the US notes that rural areas can be subject to regional neglect and issues stemming from geographical isolation such as lower broadband coverage ( 13 ). Such regional neglect is also highlighted in England, in a 2022 Parliamentary Inquiry into rural health and care ( 14 ).…”