Rural Appalachia Battling the Intersection of Two Crises

Abstract

During the COVID-19 pandemic, rural Appalachia is at great risk of unforeseen side effects including increased mortality from substance use disorders (SUDs). People living with SUDs are at increased risk for both exposure to and poor outcomes from COVID infection. The economic impacts of COVID-19 must also be considered. As rural Appalachia combats the substance use crisis amidst the COVID-19 pandemic, the geographic economic, health and social inequities within our region must be considered. As a national recovery is sought, we should reimagine federal policies that center the economic and public health of rural Appalachia addressing the two crises.

Loss of rural Appalachian recovery meetings from before to after COVID-19.

“…Recovery meetings including Alcoholics Anonymous and other 12-step style meetings are a cornerstone of recovery for those struggling with problematic substance use (Miller et al, 2020). Recovery meetings that meet regularly and can be identified by the public have historically been scarce in rural areas (Miller et al, 2020) which often have significant barriers to accessing treatment and recovery resources and have been disproportionately impacted by the opioid crisis (Young et al, 2015). We aimed to determine whether rural communities saw a decline in recovery meetings associated with the COVID-19 pandemic.…”

“…The fact that 2021 overdose deaths outpaced 2020, even as stay-at-home orders had been lifted, indicates that lifting the stay-at-home orders has not fixed the problem. Appalachian overdose deaths outpaced national increases in an area that already had significantly higher rates than the remainder of the United States (Miller et al, 2020; National Center for Health Statistics, 2022).…”

“…The suspected drivers of deaths of despair (i.e., overdose, suicide, alcoholic liver failure) include joblessness, poverty, and incarceration. These are exacerbated by problematic substance use, increased during COVID-19 lockdowns, and are more common in Appalachia than most of the United States (Miller et al, 2020).…”

“…During the COVID-19 pandemic, stay-at-home orders limited the availability of recovery meetings everywhere (Miller et al, 2020), and there has been a concurrent increase in the rate of overdoses and deaths attributable to substances since Spring of 2020 (National Center for Health Statistics, 2020). While some meetings shifted to an online format, they were not accessible to individuals with limited technology, internet access, or technological skill.…”

“…been scarce in rural areas (Miller et al, 2020) which often have significant barriers to accessing treatment and recovery resources and have been disproportionately impacted by the opioid crisis (Young et al, 2015). We aimed to determine whether rural communities saw a decline in recovery meetings associated with the COVID-19 pandemic.…”