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

Overview: Opioid overdose deaths increased during the Covid-19 pandemic, signifying the importance of treatment and support services for recovery. The present study examines the impact of the early stages of Covid-19 on an opioid support services program in rural eastern Kentucky.Proposal text: Background

During the COVID-19 pandemic, opioid overdose deaths accelerated throughout the U.S., including in the Southern region of the US (1). In 2020, there were over 100,000 drug overdose deaths (2), counting 2,000 Kentuckians (3). In 2020, Kentucky saw the third-highest increase in overdose deaths, with a 49% year-over-year increase (2,3). Effective treatment options for Opioid Use Disorder (OUD) exist, including psychosocial (4,5) and pharmacological treatments (e.g., buprenorphine; 6-8). OUD treatment capacity and availability often delay treatment in low-income rural areas (9-11). Employment issues, inadequate housing, transportation problems, and childcare needs also present barriers to accessing treatment in rural areas (12-14). These barriers and others (e.g., technology; 15) were amplified during the pandemic, negatively affecting individuals in recovery and service providers. The present study examines the impact of Covid-19 in its early stages on an opioid support services program in rural eastern Kentucky.

Methods

The present study applied a qualitative design, employing semi-structured interviews via phone and Zoom from August to October 2020. Participants were associated with one OUD support services program in rural eastern Kentucky and included 12 service recipients, three program coordinators, and four business vendors (i.e., provided services for program vouchers such as auto repair). Two investigators utilized two-cycle coding – first, descriptive coding and then, pattern coding (16).

Findings

Codes were sorted into three patterns: changes to daily life; financial impacts; and access to services. Service recipients discussed daily changes in everyday routines including additional roles they took on (e.g., home school), increased awareness of hygiene and health, and reduced emotional support. Some indicated changes caused increased stress and anxiety during an already stressful time (i.e., recovery). Regarding finances, participants shared businesses they worked for or owned closed, and although some reopened, losing income had damaging effects for several months. Considering service access, program coordinators noted changes in operations to continue programming. Coordinators conducted meetings with service recipients via phone, which proved to be difficult because of at-home distractions (e.g., children) and poor reception due to mountains and lacking infrastructure. As some clients did not have internet, technology, or knowledge about technology, getting documentation to meet policies was a challenge that previously was not an issue with in-person meetings. Coordinators often synchronized meetings with service recipients at other agencies to obtain documentation. Service recipients shared that access to other services for themselves (e.g., support groups) or children (e.g., therapy) were not available, causing frustration.

Conclusion

The present study found the early stages of Covid-19 brought increased stress for individuals in OUD recovery, as they were taking on more responsibility and navigating a constantly changing environment. Similarly, coordinators and vendors were under pressure to ensure services could be provided in a safe, convenient, and timely manner. Findings align with existing literature (e.g., 15), and add context for rural programs in OUD recovery. As Covid-19 continues and other barriers to rural OUD recovery services are exposed, these findings can help organizational leaders make realistic adjustments and help funders and policymakers set reasonable expectations and consider additional financial support.