Addressing the Spectrum of Opioid Prevention, Treatment, and Recovery in Rural Contexts: Community Identified Trends, Barriers, and Assets of Rural Counties

Background and Purpose: Opioid use in rural communities is surging while services and resources to treat and support communities and individuals at risk remain either insufficient or unavailable. In partnership with local healthcare coalitions, we conducted community needs assessments in eight eastern Washington rural counties to better understand county-specific assets and needs relating to the opioid epidemic, focusing on availability and utility of naturally-occurring and peer-led resources to support community members at risk of opioid use.

Methods: Between 2019 and 2021, 61 semi-structured interviews were conducted with key community members in eight rural counties in northwestern United States to identify county-specific characteristics of substance use and misuse, community responses to opioid misuse, prevention, treatment, and recovery efforts, barriers and challenges and community assets and strengths. The needs assessment utilized the Action-Oriented Community Diagnosis Process and drew on the mapping tools of Asset Based Community Development, which included field observations. Interview transcripts and field notes were coded and analyzed at the county level using content analysis.

Results: Data was analyzed and is reported in three categories: substance use/misuse, community response/barriers, and community assets and strengths.

Substance Use & Misuse/Opioid Use & Misuse. Opioids, alcohol, cannabis, and methamphetamines were identified as the most misused substances across all counties. Youth substance use was an emerging concern in most counties and attributed by many to community norms facilitating substance use, high levels of peer pressure, and patterns of generational use. Despite these concerns, community members consistently reported a sense of uncertainty regarding the true extent of opioid misuse in their counties due to small sample sizes and challenges with finding and interpreting county-level data.

Community Response/Barriers. Stigma emerged as a major barrier across all counties, including stigma against people with substance use disorder and stigma against treatment and recovery services such as Medication for Opioid Use Disorder (MOUD) and harm reduction programs. Community members observed stigma in acriss law enforcement, healthcare, and broader community settings. Other barriers included limited recovery services (e.g., few recovery meetings, lack of sober housing), an absence of inpatient treatment facilities, and geographic and social isolation. Isolation impacted access to care, support, and opportunities for socialization.

Community Assets/Strengths. Despite barriers imposed by social and geographic isolation, community members universally highlighted their “tight knit” communities as a strength. Community members described close relationships between families, teachers, sports coaches, and community members as protective against substance misuse because they resulted in quick recognition of problems and strong social networks. Additionally, while treatment and recovery resources are limited, community members described effective coordination between social service and health providers, resulting in more individualized care.

Conclusions and Implications: Despite challenges arising from normative cultures of substance use, lack of local services and resources, stigma, and geographic and social isolation, communities also described significant strengths that could contribute to potential interventions. Well-integrated and “tight knit” communities can protect against risks of opioid use. Future interventions should build on these community assets to support community members at risk of opioid use.