Systemic Strain: Evaluating the Effects of the Opioid Crisis on Social Service and Treatment Agencies in Appalachian Kentucky

Background and Purpose:
In Appalachian Kentucky, historically disadvantaged communities have been disproportionately impacted by the opioid crisis, placing unprecedented stress on local social service agencies. Rural systems in Kentucky are especially susceptible due to limited healthcare access, geographic isolation, lack of infrastructure (e.g., transportation, internet), higher rates of chronic pain, and low awareness about substance use dangers. Agencies such as child protective services (CPS), substance use disorder (SUD) treatment centers, and mental health services have struggled to meet growing demands. With rising opioid-related incidents, including overdoses, child maltreatment, and family separations, already limited resources have been pushed to the brink. While existing research often focuses on individuals and families with SUDs, this study aimed to assess how the crisis is affecting service provision and the workforce in local agencies.

Methods:
A mixed-methods study was conducted in early 2025 to gather information from social service providers in Appalachian Kentucky. Data were collected through an anonymous online survey (7 demographic and 9 open-ended questions) and structured in-person interviews to gain deeper insight. There were 72 survey responses and 6 interviews. Participants described professional and personal challenges, changes in families, stigma around opioid use and treatment, and unmet service needs. Quantitative survey data were analyzed using SPSS. Interview transcripts were reviewed and thematically coded. These qualitative findings were then integrated with open-ended survey responses for combined analysis and synthesis.

Results:
Findings indicate that local social service workers face fatigue, frustration, and burnout due to limited resources, understaffing, and ongoing stigma-related advocacy. Public and policymaker misunderstanding of SUDs emerged as a major barrier. Key issues that will be further explored in the presentation include regional resource scarcity, evolving family dynamics, stigma, and workforce impact.

Conclusions and Implications:
To address the opioid epidemic’s toll on Appalachian communities, there must be advocacy for increased funding, safe housing, and supportive programs. A community-based approach is critical - one that expands access to ethical, evidence-based mental health and SUD treatment, boosts community education to reduce stigma, and helps meet basic needs like shelter, food, and safety. Improving rural transportation is particularly urgent, as lack of reliable transit hinders treatment access, court compliance, and employment. Without swift and sustained interventions, the cycle of substance use and family separation will persist. However, with targeted investments, policy reforms, and community collaboration, there is hope for breaking these cycles and rebuilding stronger, healthier Appalachian communities.