It's no secret that the United States is facing a health crisis when it comes to opioid use disorders (OUD). In 2017, the U.S. Department of Health and Human Services declared the opioid epidemic a public health emergency. Sadly, little improvement has been made since then: Experts estimate that one to two million people may die from opioid overdose by 2029.
Rural communities have been hit particularly hard by the crisis. One study showed that overdose deaths increased a staggering 325% in rural counties from 1999 to 2015. On top of that, research shows that nonfatal overdoses are concentrated in states with significant rural populations.
Why are rural communities particularly vulnerable to the opioid epidemic? Accessing medication-assisted treatment (MAT) is one of the primary challenges people face in these areas. MAT is widely accepted as the most powerful treatment for OUD, and is recognized as a first-line opioid treatment by federal agencies, including the Centers for Disease Control and Prevention (CDC). But there are too many avoidable barriers that keep people from getting the treatment they need.
Let’s dive into the unique risk factors exacerbating the opioid epidemic in rural areas—and see how telemedicine is offering fresh hope to those in need.
Risk factors contributing to opioid use in rural areas
Remote communities in the U.S. are uniquely at risk for OUD for several reasons. The Rural Health Information (RHI) Hub, identifies a few key factors, including:
- A lack of education
- Lower levels of employment and corresponding low socioeconomic status
- Insufficient mental healthcare resources
There are also contextual considerations. For example, one study examining the prevalence of OUDs in rural communities found that opioids were simply more readily available in rural areas compared to urban areas.
The same study identified additional risk factors that appear to make rural communities more prone to OUD. For example, social and familial networks in rural areas may play a role in the increased use of opioids. How? Widespread, tight-knit social networks in rural communities may enable the distribution of prescription medications between community members.
Another problem the study flagged is the "out-migration" of younger populations, which leads to a lack of new economic infrastructure. This contributes to increased rates of joblessness or underemployment.
A lack of employment can lead to poverty—a unique stressor of contemporary rural living that, according to the same study, can further contribute to a risk of OUD. Other research has revealed similar trends, linking low socioeconomic status with a greater risk of opioid-related fatalities.
Barriers to care in rural communities
The reasons for the uptick in OUD cases in rural communities are complex and multifaceted. There is no "one" reason for the geographic disparities seen in the U.S. Yet another contributing cause is the fact that people in rural communities face unique challenges in accessing care.
RHI Hub explains that rural communities often have limited resources and personnel; insufficient mental health services; and no integrated system that provides the comprehensive care needed to treat OUD. For example, getting access to both MAT and individual or group counseling can be a challenge.
Opioid treatment programs (OTPs) that dispense medicines like buprenorphine, naltrexone, and methadone are critical in many OUD treatment systems. While there is a lack of OTPs across the U.S. in general, the availability gap is biggest in rural communities, with 88.6% of rural counties lacking sufficient OTPs.
This raises the issue of transportation barriers: If these care resources aren't available in the immediate community, individuals can have trouble reaching them elsewhere due to distance and a lack of reliable transportation. Methadone clinics, in particular, require in-person appointments for observation and drug safety reasons; they operate on strict schedules, so any difficulty scheduling around family caregiving responsibilities can lead people to forgo treatment.
Unfortunately, geographic barriers also add to the risks of opioid use in rural areas; if a person overdoses, emergency medical assistance may not be available fast enough.
How telemedicine + MAT are helping people access care
The above facts and figures may paint a bleak picture—and the situation is incredibly serious—but there is good news. Technology is helping fill the gaps in opioid treatment in rural communities. Telehealth addiction treatment expands access to Suboxone® and dedicated care teams to create better health outcomes.
Thanks to telemedicine, individuals can still access MAT, even if there isn’t a prescribing physician in their immediate community. They can also fit appointments into their schedule without the stress of finding transportation or the time to travel.
Telehealth addiction treatment programs have already shown success, with one survey confirming the "viability and sustainability" of delivering MAT via telemedicine to people in rural areas. Another study found no significant difference in success between virtual addiction treatment programs and face-to-face programs.
Needless to say, this is huge news. As telemedicine-based MAT programs become more normalized, the hope is that America can get a handle on the opioid epidemic in rural communities.
Getting help with Ophelia
Ophelia is committed to driving meaningful change and progress. Our online treatment platform offers MAT solutions and clinicians who are qualified to prescribe and oversee Suboxone treatment. The most important part? All care is provided in the privacy of your own home on your own time, making it easier to stay on top of appointments.
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