St. Mary’s County, Maryland has been transitioning from a predominantly rural and agrarian community to one that also includes higher-income residents affiliated with a local naval air base. With a 22% increase in population over the previous 10 years (2005-2015), St. Mary’s County has seen many changes in its community. It is with this lens that the County’s 2014 local health improvement planning process identified behavioral health as one of four health priorities needing action. The St. Mary’s County Health Department hired HRiA to examine key drivers of the County’s substance abuse issues, with an in-depth examination of opioid misuse, to inform and guide the planning and implementation of local efforts to address substance abuse issues in St. Mary’s County. HRiA conducted the assessment which addressed the following goals:
1. Engage populations disproportionately affected by substance abuse to understand underlying causes of and experiences with substance abuse in St. Mary’s County
2. Identify the perceptions, successes, and challenges to addressing substance abuse by eliciting qualitative feedback from community leaders, providers, and residents on these issues
3. Provide a portrait of the current situation in St. Mary’s County around opioid misuse by reviewing existing quantitative data
4. Informed by assessment participants, present a range of recommended strategies, approaches, or next steps relevant to St. Mary’s County

In order to meet the above goals, HRiA conducted a mixed-methods assessment, which included a review of secondary data from a variety of state and local sources related to opioid misuse, interviews with 25 community leaders and organizational staff across a range of sectors, and 7 focus groups with a variety of community residents, including those disproportionately affected by opioid misuse and substance abuse more broadly. Combined, these data sources aimed to provide insight into the root causes of substance abuse in the county, current successes and challenges across the substance abuse continuum, and opportunities for addressing these issues.