Table 1. PAST (Program implementation and opening) themes.

Theme	Category	Classification	Illustrative Quotes
1. One Size Doesn’t Fit All	a. Lack of a model program for smaller communities	Barrier	So we did a lot of research and we found out that in some cities like Baltimore there’s a syringe exchange on almost every corner at different times during the week. But we didn’t find any information about small town USA. And I’ve also been involved in outreach in [another rural community] and have just recently did a conference call with several smaller communities. That’s the key here. The smaller communities are trying to break into this but the only model that’s out there is really for more urban areas. (Free Clinic NEP Director)
2. Like A Good Neighbor	a. Community support	Facilitator	So we did a very quiet start. We did not publicize..... we knew that this would generate emotional feelings and thoughts and that we hoped people would call and ask questions and try their best to understand. The response was 14,000 dollars, and we did not ask for money. (Free Clinic NEP Director) … [A] community meeting happened in March through a local, I don’t know what you call her, just a local community member that was interested and 500 people attended that.....This was organized as a Facebook campaign by a community person. This was not organized by any official. They got the room at the library and there were 500 people up there and it was testimony after testimony from families who had lost people from people who are recovered from this addiction. And there was uniform support. And in fact it went beyond the uniform support for the effort to the question, “Why are you not doing this?” (Health Department NEP Administrator)