OPIOID AND DRUG MISUSE AND OVERDOSE IN RURAL COAL COMMUNITIES IN THE POST-COVID ERA OF ENERGY TRANSITION

This proposal aims to examine opioid and other drug misuse and overdose in rural coal communities in the post-COVID-19 era of energy transition. We focus on the Central Appalachian coal region, a mostly rural region that has long faced persistent extreme poverty and is widely regarded as an epicenter of the U.S. opioid crisis. We will also extend our analyses to other rural coal regions across the U.S.Rural coal communities in Central Appalachia have suffered a decade's coal decline, which worsened during the COVID-19 pandemic and will likely continue due to ongoing energy transition. Such sustained coal decline will likely impose challenges to economic well-being and health, for example impacting opioid and drug misuse and overdose, in rural coal communities where socioeconomic and health service resources have already been fractured and depleted.The COVID-19 pandemic has introduced both imminent and lasting challenges to opioid and drug misuse. Most notably, opioid and other drug overdoses sharply rose at the pandemic's onset. In response, the health care sector transformed the delivery of substance use treatment, such as by increasing the use of telehealth. These developments could decrease overdoses and improve recovery outcomes overall; however, they could also exacerbate socioeconomic divides and rural-urban disparities due to unequal access to technological infrastructure. Nonetheless, since the pandemic also spurred expansion of rural broadband, perhaps these disparities may not be so stark.Building upon our prior studies, we propose to use a mixed methods approach, involving integrated and iterative qualitative fieldwork and quantitative analysis, to explore how the landscape of opioid and drug misuse and overdose in rural coal communities has been impacted by the confluence of COVID-19 and energy transition, and how rural-urban, coal-noncoal, and state-level differences are unfolding. We will craft and disseminate evidence-based policy recommendations regarding economic restructuring, community development, and public health interventions that address the unique challenges facing rural coal communities but are still generalizable to broader geographies.