Rural Emergency Medical Service Providers Perceptions on the Causes of and Solutions to the Opioid Crisis: A Qualitative Assessment

Abstract

Introduction: The continuing opioid crisis poses unique challenges to remote and often under-resourced rural communities. Emergency medical service (EMS) providers serve a critical role in responding to opioid overdose for individuals living in rural or remote areas who experience opioid overdoses. They are often first at the scene of an overdose and are sometimes the only health care provider in contact with an overdose patient who either did not survive or refused additional care. As such, EMS providers have valuable perspectives to share on the causes and consequences of the opioid crisis in rural communities. Methods: EMS providers attending a statewide EMS conference serving those from greater Minnesota and surrounding states were invited to take a 2-question survey asking them to reflect upon what they believed to be the causes of the opioid crisis and what they saw as the solutions to the opioid crisis. Results were coded and categorized using a Consensual Qualitative Research approach. Results: EMS providers’ perceptions on causes of the opioid crisis were categorized into 5 main domains: overprescribing, ease of access, socioeconomic vulnerability, mental health concerns, and lack of resources and education. Responses focused on solutions to address the opioid crisis were categorized into 5 main domains: need for increased education, enhanced opioid oversight, increased access to treatment programs, alternative therapies for pain management, and addressing socioeconomic vulnerabilities. Conclusion: Along with the recognition that the opioid crisis was at least partially caused by overprescribing, rural EMS providers who participated in this study recognized the critical role of social determinants of health in perpetuating opioid-related harm. Participants in this study reported that education and increased access to treatment facilities and appropriate pain management, along with recognition of the role of social determinants of health in opioid dependency, were necessary steps to address the opioid crisis.

A Qualitative Analysis of Emergency Medical Services Personnel Experiences and Perception Responding to Drug Overdoses in the US during the COVID-19 Pandemic

“…This qualitative study provided insights into the experiences of EMS personnel in responding to substance use-related calls, especially during the COVID-19 pandemic on top of the opioid crisis in the US. EMS personnel are critical stakeholders in combating the opioid crisis; they are often the first health care provider called to the overdose scene [ 1 , 23 ]. Therefore, it is essential to understand the needs of EMS personnel directly from them to provide the resources and training needed to address those needs, which our findings provide.…”

Care coordination between rural primary care and telemedicine to expand medication treatment for opioid use disorder: Results from a single‐arm, multisite feasibility study

“…Even before the pandemic, the opioid crisis in highly impacted rural areas led to the recommendation that TM‐based medication treatment for opioid use disorder (MOUD) might offer a means to expand treatment access and improve retention of MOUD in rural areas 3,4 . Rural communities are of particular concern because they are disproportionately impacted by opioid use disorder (OUD) and encounter many challenges to accessing MOUD (eg, limited availability of MOUD services, economic distress, older populations, social isolation, and travel burden) 5–10 . Studies comparing in‐person and TM‐based MOUD generally showed comparable effectiveness and even better retention outcomes in TM‐based MOUD 11–13 .…”

“…3,4 Rural communities are of particular concern because they are disproportionately impacted by opioid use disorder (OUD) and encounter many challenges to accessing MOUD (eg, limited availability of MOUD services, economic distress, older populations, social isolation, and travel burden). [5][6][7][8][9][10] Studies comparing in-person and TM-based MOUD generally showed comparable effectiveness and even better retention outcomes in TM-based MOUD. [11][12][13] According to a recent study, the policy changes supportive of TM implemented during the COVID-19 pandemic had a positive effect on the access to health care and clinical outcomes of rural patients with OUD.…”

Medication treatment for opioid use disorder among rural primary care patients

“…Rates of opioid overdose deaths have increased in the United States over the past 15 years and continue to rise in the context of the COVID‐19 pandemic 1,2 . Rural communities are of particular concern because they are disproportionately impacted by the opioid crisis and encounter many challenges to accessing medication treatment for OUD (MOUD), such as limited availability of MOUD services, economic distress, older populations, social isolation, and travel burden 3–8 …”

“…1,2 Rural communities are of particular concern because they are disproportionately impacted by the opioid crisis and encounter many challenges to accessing medication treatment for OUD (MOUD), such as limited availability of MOUD services, economic distress, older populations, social isolation, and travel burden. [3][4][5][6][7][8] Few studies have investigated the prevalence rate of OUD and the rate of MOUD in rural communities. A study that used electronic health records (EHRs) during the years 2014-2016 in 6 urban health care TA B L E 1 Numbers and prevalence rates of patients with OUD and MOUD in the 6 sites during the 15-month study period.…”