Moving HEAL Research into Action

Clean Energy Transition, COVID-19, and OUD in Coal Communities

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A clean energy transition, from one dominated by fossil fuel to one powered by low- to no-carbon sources, is critical to mitigating climate change and protecting human health. The transition will affect most aspects of life, creating new opportunities as well as causing job losses in legacy industries. This research focuses on opioid use disorder (OUD) in communities that rely on legacy industries and have been (or will be) negatively impacted by the transition, highlighting the importance for a just energy transition.

In our prior work we have examined the impacts of the post-2010 decline in coal mining (largely due to decrease in demand for coal) on opioid overdose mortality in rural coal communities in central Appalachia. Employing a county-by-year longitudinal data covering 48 rural coal counties in central Appalachia during 2010-2017, we find that even after controlling for socioeconomic and health service variables and opioid prescription rates, opioid overdose death rates are significantly and negatively associated with coal mining (either measured by coal production or coal miner employment), suggesting that the coal mining decline has had negative impacts on the opioid crisis in those coal communities.

The COVID-19 pandemic, which has disproportionately impacted already disadvantaged and vulnerable populations, could have lasting impacts on the opioid crisis, beyond introducing imminent challenges including increased anxiety and social isolation, struggles in continuing treatment and economic difficulty. In particular, a comprehensive treatment approach involving medication assisted treatment (MAT), proving to be effective in reducing opioid overdoses and increasing retention, has faced an unprecedented set of obstacles during COVID-19 (as in-person counseling, medication administering and monitoring has become challenging). In response, opioid treatment facilities have made adjustments to become more flexible, some of which, such as increased use of telehealth, will be likely maintained after COVID-19, but could further exacerbate existing socioeconomic divides and rural-urban gaps, including lack of technology (e.g. computers and cell phones) and infrastructure (e.g. broad band accessibility), in particular in communities where such infrastructures have been insufficient.

Moreover, the COVID pandemic has accelerated the decline in coal mining, imposing additional challenges in coal communities where economic and social resources have already been fractured and depleted. The quarterly coal production and employment data from EIA (Energy Information Agency) shows that, despite that coal mining has been designated as an essential business, coal production and employment in rural central Appalachia sank during the first half of 2020 and did not improve much in the third and fourth quarter following reopening.

This research aims to gain better understanding about how individuals, communities, and opioid treatment facilities in coal communities in Central Appalachia have been impacted by the confluence of energy transition and COVID-19. We will explore how coal-noncoal divides and rural-urban disparities have unfolded and impacted OUD, during and following the COVID-19 pandemic. In particular we will investigating and how adjustment made by opioid treatment facilities has impacted opioid treatment in socioeconomically disadvantaged coal communities with already insufficient opioid treatment infrastructure, and how the blow on the struggling coal industry by the COVID-19 has created additional challenges in coal communities where economic and social resources have already been fractured and depleted.

The research will provide useful insights on how the opioid crisis might be unfolding in the post-COVID era of clean energy transition during which coal mining will continue its decline and more flexible opioid treatment policies and practices will be in place or even expanded. The findings will be tailored to coal communities, but will provide useful insights for combatting the opioid crisis in other regions reliant on legacy industries.

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