Emergency preparedness planning: lessons from COVID-19 and the opioid crisis in rural Ohio
First author · Westlund BR, Sibley AL, Colston DC, Devadas J, Enderle MN, Piscalko HM, Miller WC, Go VF
The COVID-19 pandemic amplified an already severe overdose crisis, but its effect on rural emergency preparedness was largely undocumented. Drawing on 52 semi-structured interviews with people who use drugs and local stakeholders across two Appalachian Ohio counties, this study found that existing preparedness plans were outdated, unfamiliar to staff, and built for short-term disasters rather than sustained public health emergencies — with almost no consideration of the needs of people who use drugs. Service disruptions, inconsistent communication, and heightened stigma compounded the harm, though communities responded with peer distribution networks and rapid telehealth adoption.
DOI: 10.64898/2026.07.30.26359388 ↗The central finding is a design failure: plans existed, but the people meant to use them couldn't find them, didn't recognize them, and weren't represented in them. Systems fail the same way products do — when they're built without the end user in the room.