Rural areas with limited access to preventive care, treatment, and recovery services are particularly affected by the opioid crisis. This study identified four rural areas in Alabama that had higher opioid prescription rates than the state and national average. This study explores the views of three groups [healthcare service providers, persons who use/used opioids (PWUO), and community stakeholders] on the barriers to and needs for opioid prevention, treatment, and recovery services using a phenomenological qualitative design. Purposeful and snowball sampling was used to recruit 95 participants across 12 focus groups which were audio-recorded and transcribed verbatim. A seven-member analysis team conducted a directed content analysis using a semi-structured script and seeded themes with a rigorous plan to promote trustworthiness. Regardless of group type, commonly identified barriers and needs related to rural locality, financial factors, cultural norms, and stigma among others. Prominent needs included education and healthcare coordination. Findings suggest recommendations for community and provider interventions to address the knowledge gaps and recovery needs. They also supported the suitability of the Telehealth Extension for Community Healthcare Outcomes, a videoconferencing tool that networks multidisciplinary experts and professionals around specialty topics, as a promising intervention to increase training among providers.


phenomenology, rural, opioids, opioid crisis, challenges, needs, Alabama, directed content analysis, community-engaged research, focus groups, prevention, treatment, recovery

Author Bio(s)

Joshua C. Eyer, Ph.D., (https://orcid.org/0000-0002-1668-6268) is the Founding Director of the South Regional Drug Data Research Center in the Institute of Data & Analytics at the University of Alabama, Tuscaloosa, AL, jceyer@ua.edu

Cho Rong Won, M.S.W., (https://orcid.org/0000-0003-2519-4748) is a Doctoral Candidate, School of Social Work, University of Alabama, Tuscaloosa, AL, cwon@crimson.ua.edu. Please direct correspondence to cwon@crimson.ua.edu

Megan Sawyer, L.M.S.W., is an Acute Psychiatry Social Worker for the Veterans Health Administration, Portland, Oregon, masawyer@ua.edu

Yan Luo, M.S.W., (https://orcid.org/0000-0003-0338-0371) is a Doctoral Candidate, School of Social Work, University of Alabama, Tuscaloosa, AL, yluo30@crimson.ua.edu

Kun Wang, Ph.D., M.S.W., (https://orcid.org/0000-0002-0606-1950) is an Assistant Professor, College of Community and Public Affairs, Binghamton University, Binghamton, NY, kwang8@binghamton.edu

Edson Chipalo, M.S.W., Ph.D., (https://orcid.org/0000-0002-4336-8329) is an Assistant Professor, College of Education and Social Sciences, Lewis University, Romeoville, IL, echipalo@lewisu.edu

Gwen Thomas-Leblanc, M.S., C.C.S., is Clinical Director of Substance Use Disorder Services, Northwest Alabama Mental Health, Winfield, AL, gwen.thomasleblanc@nwamhc.com

Hee Yun Lee, Ph.D., M.S.W., (https://orcid.org/0000-0003-3499-6304) is a Professor, Endowed Academic Chair on Social Work (Health), School of Social Work, University of Alabama, Tuscaloosa, AL, hlee94@ua.edu


We wish to thank our GROW consortium members and the residents of the communities in northwest Alabama who participated in this study. Their efforts to assist in this work while coping with the tremendous challenges of the opioid crisis demonstrate their enthusiasm, courage, and determination. We are grateful for their assistance. This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $200,000 with 0% financed with non-governmental sources. The contents are those of the authors and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.

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This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 4.0 International License.




0000-0002-1668-6268, 0000-0003-2519-4748, 0000-0003-0338-0371, 0000-0002-0606-1950, 0000-0002-4336-8329, 0000-0003-3499-6304





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