Emergency preparedness planning: lessons from COVID-19 and the opioid crisis in rural Ohio.

The COVID-19 pandemic amplified existing public health emergencies, including the overdose crisis. In rural areas, the effect of emergency preparedness planning on local responses to the pandemic is unknown. We conducted 52 semi-structured interviews with two participant groups (28 people who use drugs [PWUD] and 24 local stakeholders) in two rural counties in southern Ohio. Interviews explored service disruptions, perceptions of the pandemic, organizations' pre-existing emergency plans, and communication channels. Transcripts were analyzed thematically to identify data patterns within and between stakeholders and PWUD. Emergency preparedness plans were often inadequate for the needs of PWUD. Several stakeholders reported that their organizations' existing plans required updates and additional PWUD perspectives to respond effectively to pandemic-related needs. Both PWUD and stakeholders described widespread service disruptions, including reduced hours, understaffing, and limited access to supplies. Communication was inconsistent, contributing to challenges in maintaining trust and ensuring access to accurate information. Heightened stigma and law enforcement protocols further discouraged the use of essential services. Despite these challenges, PWUD and stakeholders showed resilience and identified community-driven solutions, including peer distribution networks and rapid transition to telehealth services to mitigate these harms. The COVID-19 pandemic exposed critical gaps in existing emergency preparedness plans for PWUD in rural Ohio. Ensuring the continuity of essential services, strengthening communication channels, and integrating PWUD perspectives into future emergency preparedness plans are essential to improve responses to future emergencies.