Opioids, Needle Exchange, and Barriers to Care in the Rural Context: Interviews with Law Enforcement and Emergency Medical Personnel

Abstract

Background The large increase in opioid use, subsequent addiction and related death has come to be known as a national epidemic in the United States, particularly affecting rural areas. The crisis has been met with an increase in attempts to address the large overdose rates. In many of these strategies, first responders such as police and emergency services personnel are placed on the front lines. The input and opinions of these individuals, and the communication with them from agency leadership during program implementation can dramatically affect the success of drug related policies. However, there is a paucity of research focused on the attitudes of primary responders, particularly in rural settings. This study conducts a geographically-focused investigation into the attitudes of rural EMS and law enforcement personnel in regards to opioid treatment in a location that was currently implementing a major substance use policy. Methods Qualitative semi-structured interviews were conducted with 24 members of law enforcement and 22 emergency medical providers within a single rural county in North Carolina. Interviews spanned three sections: demographics, barriers to opioid treatment and county-specific programs. Results The largest barriers to care cited were lack of local treatment resources, the stigma against drug use and a perception that people who use opioids did not want to change. A multi-agency approach to the crisis was supported by EMS personnel and law enforcement. However, first responders awareness of an active multiagency county-wide initiative was very limited. This was very surprising, as first responders were expected to implement the program, and this phenomena resulted in very low program efficacy to that point. This result underscored the importance of communication between and within agencies, particularly in environments that are resource-constrained. Conclusions This study is unique in comparing attitudes of rural EMS and law enforcement regarding substance use treatment. This paper provides insight into the viewpoints of rural first responders, with clear implications for rural drug policy. This paper further underscores opportunities for maximizing effective opioid policy in rural settings, particularly emphasizing clear communication between agencies.