From 2020 to 2021, opioid-related overdose deaths in Louisiana rose a disproportionate 56.2% compared to 29.6% nationally. While evidence-based treatment for OUD is highly effective, access to care and retention are critical. Stressors associated with COVID-19 and climate event influence overdose risk among people with OUD in Louisiana. We are conducting a study to describe impacts of environmental stressors on 1) Louisiana Medicaid members (LMM) with OUD and 2) delivery of clinical services, including medication-assisted therapy (MAT), for OUD.

Methods

We applied Rapid Assessment Procedures-Informed Community Ethnography to conduct this qualitative study. We employed community-partnered participatory research framework to engage a diverse Leadership Council to co-lead study design and implementation. To date, we have conducted 17 interviews with LMM with OUD. Interviews are analyzed by summarization of transcripts to parse content within target domains and identification of patterns using thematic analysis and the matrix method. We identified 6 target domains from interviews: emergency disaster plans, provider communication, environmental stressors, healthcare adaptations, telehealth, and increases in overdoses.

Results

Participants interviewed are 58% female with mean age of 42.83 years from 7 Louisiana parishes. Although some members reported frequent communication with their providers during emergency closures, others reported communication lapses resulting in medication gaps or relapse. Members identified factors to contributing overdose: fentanyl, scarcity of Narcan, treatment inaccessibility, job loss, displacement, and mental illness. Generally, telehealth was described as convenient and helpful in maintaining care.

Conclusions

Louisiana Medicaid Members in treatment for OUD report reduced quality of medical care due to inaccessibility, economic hardship, mental and physical health challenges, and diminished social support related to COVID-19 and hurricanes since 2020. Direct communication mechanisms with providers and telehealth were perceived as protective against attrition and relapse. However, members express an ongoing need for access to MAT and harm reduction to improve care for OUD during stressors such as pandemic surges or climate events.