Degree Name

DrPH (Doctor of Public Health)

Program

Public Health

Date of Award

5-2026

Committee Chair or Co-Chairs

Kate Beatty

Committee Members

Megan Quinn, Michael Smith

Abstract

Background: Opioid use disorder (OUD) represents a critical public health crisis disproportionately affecting justice-involved (JI) populations, with approximately 65% of incarcerated individuals having substance use disorders (James & Beatty, 2006). Rural Appalachian communities face compounded challenges due to limited healthcare access, provider shortages, and cultural stigma surrounding addiction treatment. Despite evidence demonstrating that medication-assisted treatment (MAT) reduces recidivism and overdose deaths, only 20% of correctional facilities offer these services (Klein & Seppala, 2019).

Objective: This mixed-methods study evaluated organizational readiness and infrastructure capacity for implementing evidence-based OUD interventions, specifically MAT programs across three rural counties in northwestern North Carolina.

Methods: This study integrated quantitative analysis of emergency department overdose surveillance data from NC DETECT with qualitative key informant interviews conducted across multiple stakeholder groups. The Rigorous and Accelerated Data Reduction (RADaR) technique will be the primary rapid coding method used to analyze the key informant interview transcripts.

Results: Results revealed that 74% of informants had no formal OUD training and 67% had no MAT training, yet 89% expressed confidence in interacting with individuals with OUD, suggesting a confidence-competence gap. All informants (100%) agreed that MAT training should be provided across professional roles, yet only 33% had received any MAT information from professionals.

Opioid overdose-related emergency department (ED) utilization was examined across 15 zip codes spanning three counties in western North Carolina: Alleghany, Ashe, and Watauga during the measurement period of January 1, 2024, to July 31, 2025The visit-weighted average statewide across the region was 61.3 per 100,000 residents, which exceeds the state average of 49.4 (CDC, 2026).

Conclusions: The research revealed a workforce deeply engaged with the opioid crisis yet under-equipped to respond. Challenges identified include transportation, limited resources, safety, financial barriers, and stigma, all of which are systemic, but training offers an actionable entry point given the unanimous demand. Recommendations include deploying a modular MAT training curriculum across all stakeholder roles, establishing warm handoff protocols, and implementing MAT in local correctional facilities. The informants in this research are not resistant to change; they are requesting it, and the momentum to address institutionalized stigma at the grassroots level exists.

Document Type

Dissertation - unrestricted

Copyright

Copyright by the authors.

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