Overdose Prevention and Workforce Development Needs: Differences By Locality and Population Density In the Pacific Southwest Region

Background and Purpose

Despite efforts to expand substance use treatment and overdose prevention services, the behavioral health field continues to experience significant resource and training gaps. Availability of training in evidence-based practices and access to overdose prevention materials, including overdose-reversal medications, vary across states and municipalities, with urban centers typically experiencing greater access. The Pacific Southwest Addiction Technology Transfer Center (ATTC) administers an annual needs assessment to the behavioral health workforce across HHS Region 9, including California, Nevada, Arizona, Hawai’i, and the Pacific Islands affiliated with the U.S. This study analyzes results from the 2024-2025 Regional Needs Assessment, focusing on differences in training needs, provider preparedness, and access to overdose prevention resources. We hypothesized that access to resources would be positively associated with provider confidence to respond to client overdose, and that this association may vary across urban and rural/tribal localities.

Methods

An online survey of HHS Region 9 behavioral health providers (N=451) was administered between December 2024 and February 2025. Providers reported confidence in applying evidence-based modalities and overdose prevention services, interest in additional training, and access to overdose prevention resources. Confidence was measured using a 5-item Likert scale; access to overdose prevention materials was measured using a 4-item Likert scale. Analyses stratified providers by location into four groups, including the three states on the continent (California, Nevada, Arizona) and Hawai’i and the PIaUS. Multivariate linear regression models with interaction terms assessed the effect of resource access on confidence to provide overdose prevention services, as moderated by urban/rural status.

Results

Most respondents worked in urban areas (67.9%). The largest proportion of the sample worked in California (41.4%), followed by HI/PIaUS (23.9%), Nevada (15.3%), and Arizona (12.9%). Respondents reported lowest confidence to provide DBT (47.2%), housing support (41.2%), and medication assisted treatment (38.4%). Providers reported the greatest interest in receiving training in crisis intervention (88.3%), cognitive behavioral therapy (85%), and trauma-informed care (85.5%). Confidence to provide overdose prevention services was lower in the island states and territories (55.6%) and Nevada (64.9%) than in California (83.9%) and Arizona (83.9%). Regression analyses identified main effects of urban location (B=0.61, p=.05) and access to overdose prevention materials (B=0.46, p<.001) on greater confidence to provide overdose prevention services. The interaction between location and access to overdose prevention materials was not significant (B=-0.11, p=.34), indicating that the relationship between access and confidence did not vary across urban/rural settings.

Conclusions and Implications

Provider confidence, training needs, and access to overdose prevention materials in HHS Region 9 differed by location and urban/rural setting. Both urban and rural/tribal providers reported higher confidence with overdose prevention services when their access to resources was greater. However, providers in rural/tribal areas reported lower access overall. Expanding material access in rural and tribal areas may be an important focus of training and technical assistance systems to address the overdose crisis.