Like most of the health care system, services for people with substance use disorder (SUD) were deeply impacted by COVID-19. As the pandemic raged, challenges emerged for patients with SUDs due to physical, economic, social, and behavioral vulnerabilities caused by shifts in drug supplies, social and physical isolation, increased unemployment, and减少获得治疗和康复服务。致命的结果是record 30% spikein U.S. overdose deaths accompanied by increases in non-fatal overdoses according to both国民andregionalsources. This blog post describes the experiences and COVID-19 induced challenges encountered by the projects funded under the Health Resources and Services Administration’s (HRSA)Rural Communities Opioid Response Program (RCORP)。

rcorpbackground

rcorp是一项庞大的多年联邦倡议，涉及SUD患者的预防，治疗和恢复。通过HRSA管理联邦农村卫生政策办公室，，，，rcorpfunds数百名受赠人在五个类别中：规划，，，，执行，，，，扩张阿片类药物使用障碍的药物，Neonatal Abstinence Syndrome，，，，and精神刺激剂。Grantees comprise diverse organizations including primary care centers, Federally Qualified Health Centers, universities, critical access hospitals, local governments and health agencies, rural hospitals, and other providers and community-based organizations.

适应：优势和利益

随着大流行的发展，暴露恐惧，安全指南和身体远处迅速减少了面对面的相互作用。作为回应，RCORP项目扩展了远程医疗，将许多服务转向在线交付。一些RCORP受赠人已经拥有远程医疗基础设施。其他人必须创建它。到2020年第四季度，报告显示，RCORP授予者的86％至92％扩大了远程医疗服务（资料来源：2020年12月的季度进度报告，Mun，C.，Schachtner，R.，Rupp，S.，Kuritzky，A.Bresani，E。，＆Meyers，K。（2021）。Reaching Rural Residents in the Era of COVID-19: RCORP Consortiums and SUD/OUD-related Service Delivery as Reported in PIMS.Report prepared for the Health Resources and Services Administration. North Bethesda, MD: JBS International, Inc.). Necessity prompted an evolution over months that may otherwise have taken years.

This pivot was enabled by许多因素: a) Relaxation of regulatory barriers (e.g.,online waiver certification），b）办公室和远程医疗访问之间的报销均等，c）患者买入，d）轻松的跨州许可，e）感谢远程医疗的安全性，便利性和降低的成本。

同行恢复服务遭受了艰难的打击，但对于那些可以访问虚拟恢复会议的人来说，这是一个亮点，使参与者可以将个性，背景和样式与全球各地的团体相匹配。RCORP试图跟踪新的虚拟会议，但是很难跟上快速增加的机会（例如，例如，In the Rooms，，，，Narcotics Anonymous Meetings，，，，and连接）。

适应：挑战

Despite these benefits, challenges remained.Surveysreported up to a three-fold increase in anxiety and depression symptoms and a two-fold increase in the prevalence of suicidal ideation. NationalEmergency Medical Servicedata also showed a sharp rise in the rate of mental/behavioral EMS service activations. Critically, however,CDC (Centers for Disease Control)andothershave shown that the COVID-19 pandemic did not consistently increase all-age U.S. suicide mortality.

• 较少的服务：In rural areas, budgets are often small due to limited economies of scale, low population density, small organization size, and high poverty rates. Many rural areas saw health services reduced or suspended. The likelihood of reviving these services in rural communities remains uncertain.
• 连接：由于长距离和成本，差距仍存在于座机，蜂窝和宽带连通性中，许多人口在农村和边境地区未被保留。
• Lack of Fit:Mental health disorders are common among patients with SUD. Telehealth may not be appropriate for individuals with co-occurring SUD and severe mental illness (e.g., active psychosis, suicidality) or when patient confidentiality is critical (e.g., child maltreatment, domestic violence).

结论

这枢to telehealth during the COVID-19 pandemic led to its increased acceptance by rural patients and providers. Telehealth has helped reduce transportation costs and increased access to specialists. These efforts will continue because telehealth can assist financially struggling providers, increasing the continuity of care despite the barriers presented by in-person services. The pandemic response added resources and focus and enhanced consumer familiarity with telehealth. In some SUD service settings (e.g., jail and prisons), necessity inspired novel resources and partnerships that overcame long-standing barriers.

Many RCORP grantees increasingly believe that the benefits of telehealth can be sustained. However, rural areas will also need time andresourcesto take advantage of gap-filling technological advancements such as 5G and satellite broadband to bring telehealth to everyone.

大流行期间的远程医疗改变了许多RCORP提供商开展业务的方式。随着面对面考试和其他服务恢复的增加，远程医疗和面对面服务的融合将为不同的人群和设置创造正确的平衡，这对于确定的情况至关重要，对现场和远程医疗服务的适当报销也是如此。

Acknowledgement： 这Rural Communities Opioid Response Program Technical Assistance (RCORP-TA)is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U6BRH32364, totaling $6,000,000 with 0% financed with non-governmental sources. This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.