Opioid Overdose Risk and Recovery Barriers: A Mixed Methods Study of Perspectives From a Community

OBJECTIVES: According to the Centers for Disease Control and Prevention, opioid-related deaths in the United States have increased steadily during the past 20 years, contributing to a major public health emergency. In Nebraska's most populous county, Douglas County, the drug overdose mortality rate nearly doubled from 2015 to 2021. This study assessed the current needs, barriers, and priorities related to opioid use and overdose in Douglas County to inform local response strategies. METHODS: We used a mixed methods explanatory sequential design that included (1) surveys of people with lived and living experience of substance use and their family members or support people and (2) interviews with leaders and staff of community-based organizations in Douglas County. RESULTS: Seventy-three people completed surveys, and 8 community partners participated in qualitative interviews. The main service needs identified were (1) specific treatment options for women with children, (2) primary care providers offering medication-assisted therapy, and (3) peer-run services. In addition, individuals who were recently incarcerated had distinct challenges. A cross-cutting theme was the need for community understanding and education about substance use, particularly as it relates to stigma as a barrier to treatment and to obtaining naloxone. Both survey and qualitative results indicated a need to improve access to naloxone and to strengthen community-level understanding of its use. Unmet social needs, including unstable housing, food insecurity, and transportation barriers, were identified as contributing factors to substance use and to difficulties accessing treatment. CONCLUSIONS: This study identified current community needs and barriers in addressing the opioid crisis in Douglas County. The findings provide guidance for ongoing efforts to reduce opioid-related overdose deaths.