Resilient Evidence-Based Policies in Rural Regions: Exploring the Intersection of COVID-19 and Opioid Use Disorder

• In Event: Co-Producing Resilience: Community, Collaboration, and Policy in Crisis Response

Abstract

Rural areas of the United States face unique challenges in regard to healthcare, infrastructure, employment, and addiction, and in some cases, the COVID-19 pandemic has exacerbated these issues. Specifically, the opioid crisis has profoundly impacted rural catchments, as demonstrated by the 390% increase in drug overdose deaths from 1999 to 2019. Though medications for opioid use disorder (MOUD) are recognized as safe and effective treatments for individuals with opioid use disorder (OUD), the availability and utilization of these medications in rural areas remain limited due to factors such as a shortage of trained healthcare professionals, stigma surrounding MOUD, and logistical challenges like long travel distances to clinics. The COVID-19 pandemic altered the use of MOUD as a result of a lack of face-to-face interaction and subsequent changes to policy; however, the extent of pandemic-related effects in rural areas is not known. 

The current study aims to answer the following research questions: Have rates of MOUD utilization changed following the COVID-19 pandemic? Have such changes differed across urban and rural catchments? Do results differ across treatment modalities? Using 2018–2022 Treatment Episode Data Set Admissions (TEDS-A) data, we explore these questions via interrupted time series regression models with state-level fixed effects. Analyses are disaggregated into models for outpatient, long-term residential, and short-term residential treatment to account for heterogeneity across modalities. Preliminary results show that the usage of MOUD as part of a treatment plan at intake increased following the COVID-19 pandemic, particularly in residential treatment programs. However, patients in rural regions were less likely to utilize MOUD and this temporal increase was less pronounced in these catchments. In outpatient and long-term residential treatment centers in rural regions, rates of MOUD decreased from 2021 to 2022, demonstrating variations in post-pandemic years. 

These findings highlight the need for collaborative partnerships between policymakers, healthcare providers, and community organizations to develop resilient evidence-based policy solutions in rural areas experiencing MOUD-related disparities. Our research provides evidence to formulate policy solutions that are adaptable to rural regions and address challenges at the intersection of the COVID-19 pandemic and opioid crisis. The short-lived positive effects of flexible MOUD-related pandemic policies in rural regions underscores the need for inclusive, transformative solutions that consider the unique conditions in these catchments. Effective implementation requires coordination across stakeholders to ensure equitable access to evidence-based treatments across geographic settings.

Authors

• Ryan Lofaro, Georgia Southern University
  Presenting Author

• Robert Bohler, Georgia Southern University
  Non-Presenting Co-Author

• Jessica Smith Schwind, Georgia Southern University
  Non-Presenting Co-Author