Leveraging Policy Changes Made in Response to COVID-19 to Advance Telehealth and Novel Treatment Approaches for People Who Use Opioids: Qualitative Perspectives From Two Rural North Carolina Counties

Background: The COVID-19 pandemic has been a catalyst for telehealth services for people who use opioids; however, the data show dramatic increases in opioid overdose deaths and ongoing lack of treatment options in North Carolina, particularly among rural residents.

Methods: We conducted a listening session and qualitative interviews with 10 health care professionals, administrators, and community partners providing services for individuals who use opioids in Granville and Vance counties. Data were analyzed with an applied thematic approach.

Results: Participants described several benefits of rapid expansion of telehealth services during the pandemic. Continued improvements in access to high-speed internet will be critical to maintain progress in rural areas. Participants advocated for integrated, co-located ser-vices and improved referral processes to minimize cost and burden of attending multiple appointments across sites. Integrated services could include medication for opioid use disorder (MOUD), mental/behavioral health support, primary medical care, and harm reduction services. Participants supported novel community-based strategies, such as mobile clinics, and described a need for after-hours and crisis services for opioid recovery in the region.

Limitations: The study was exploratory in nature and elicited the perspectives of providers serving two rural counties in North Carolina, which may not be generalizable to broader populations. We did not include the perspectives of people who use opioids in this study but will do so in upcoming research.

Conclusions: Participants were strong proponents of the benefits of telehealth and identified strategies for continuing recent progress in rural access to opioid treatment through novel integrated and community-based approaches.