Studying the Openness to and Feasibility of Using Drones As a Novel Way to Address the Substance Abuse Crisis in Rural Appalachia

Background and Purpose: The national opioid misuse crisis has reached epidemic levels (Spencer, 2022). Rural residents are disproportionately vulnerable due to infrastructure inequities that exacerbate healthcare accessibility gaps. Gelberg and colleagues’ (2000) behavioral model for vulnerable populations (BMVP) provides context for understanding how aspects of the built environment impede health-seeking behaviors. The current study explores a highly novel way to address infrastructure barriers – drones to deliver SU healthcare resources (e.g., clean needles, Narcan). We report on mixed-method study of community members’ self-reported barriers to care, services available, and openness to drones for SU healthcare, triangulated with subject matter experts’ (SME) perspectives on feasibility.

Methods: Survey data were collected from rural east Tennessee consumers of SU healthcare (N=121) regarding: 1) barriers to services (13 items, 3-point Likert scale), 2) services available (8 items, dichotomized), and 3) attitudes towards drones (6 items, 3-point Likert scale). Domain items were summed to create composite scores. Following bivariate tests, a sequential linear regression model tested whether SU accessibility and living situation predicted openness to drones. Additionally, two structured discussions were conducted with SMEs, and one with individuals experiencing seeking services for SU. Direct content analysis and iterative axial coding were used to identify central themes across discussions.

Results: The survey sample was racially/ethnically diverse and lower-resourced (52.1% female, 59.5% Non-Hispanic White, 45.8% with inconsistent/no car, 26% in temporary/impermanent housing). Transportation was the most frequently endorsed barrier to care (74%). Among services, mobile clinics (56%) and home visits (61%) were most identified as “not available”. Half (50%,) reported that they would trust drones, but just 35% agreed that their communities would. T-tests showed that those living in temporary/impermanent housing, compared to homeowners and renters, were more open to drones (M=3.45, SD=2.42 vs. M=2.41, SD=1.95, p=.018), and those citing transportation as a barrier reported a higher mean number of barriers overall (M=7.08, SD=3.00 vs. M=4.53, SD=2.36, p<.001). In the regression model, being in-treatment predicted a drop in openness to drones (B = -.234, 95% CI [-1.956, -.269]), while living in temporary/impermanent housing (B=.187, 95% CI [-.310, 1.965]) and having a higher composite score on service barriers (B=.182, 95% CI [.001, .246]) predicted an increase. The latter two variables also explained an additional 7% variance in openness to drones.

Discussion participants (N=9) were predominantly female (75%). Across all participants, transportation was again the most common barrier to SU services, but stigma/judgement were also frequently mentioned. SMEs identified implementation concerns due to regulations regarding airspace and controlled substances. Individuals with lived experience said drones would be useful for delivering clean needles and recognized that unsheltered individuals might benefit most from drone delivery.

Discussion: Empirical findings support the BMVP indicating that community-level infrastructure does influence people’s help-seeking behaviors. Thus, infrastructure is an opportunity for macro-level interventions to help reduce opioid use at a population-level. Using drones to deliver harm reduction resources (e.g., clean needles, Narcan, and even food and blankets) may be useful in combatting the opioid epidemic, and particularly targeting individuals experiencing homelessness in rural communities.