A systematic review of rural-specific barriers to medication treatment for opioid use disorder in the United States

Abstract

Background: Opioid-related deaths have risen dramatically in rural communities. Prior studies highlight few medication treatment providers for opioid use disorder in rural communities, though literature has yet to examine rural-specific treatment barriers. Objectives: We conducted a systematic review to highlight the state of knowledge around rural medication treatment for opioid use disorder, identify consumer-and provider-focused treatment barriers, and discuss rural-specific implications. Methods: We systematically reviewed the literature using PsycINFO, Web of Science, and PubMed databases (January 2018). Articles meeting inclusion criteria involved rural samples or urban/rural comparisons targeting outpatient medication treatment for opioid use disorder, and were conducted in the U.S. to minimize healthcare differences. Our analysis categorized consumer-and/or providerfocused barriers, and coded barriers as related to treatment availability, accessibility, and/or acceptability. Results: Eighteen articles met inclusion, 15 which addressed consumer-focused barriers, while seven articles reported provider-focused barriers. Availability barriers were most commonly reported across consumer (n = 10) and provider (n = 5) studies, and included the lack of clinics/providers, backup, and resources. Acceptability barriers, described in three consumer and five provider studies, identified negative provider attitudes about addiction treatment, and providers' perceptions of treatment as unsatisfactory for rural patients. Finally, accessibility barriers related to travel and cost were detailed in four consumer-focused studies whereas two provider-focused studies identified time constraints. Conclusions: Our findings consistently identified a lack of medication providers and rural-specific implementation challenges. This review highlights a lack of rural-focused studies involving consumer participants, treatment outcomes, or barriers impacting underserved populations. There is a need for innovative treatment delivery for opioid use disorder in rural communities and interventions targeting provider attitudes.

Three-month outcomes from a patient-centered program to treat opioid use disorder in Iowa, USA

“…Opioid-related deaths have risen dramatically in rural communities over the past decade and in 2015, the rural overdose death rate surpassed the urban overdose death rate. Yet access to MAT remains elusive for many rural communities, and there is a lack of studies on participants, treatment outcomes, and barriers to medication treatment for opioid use disorder in rural communities [45]. One of the strengths of our study was that a quarter of the participants live in rural communities.…”

Overcoming Barriers: Individual Experiences Obtaining Medication-Assisted Treatment for Opioid Use Disorder

“…Yet significant disparities in substance abuse treatment persist nationally in rural areas. Rural individuals seeking treatment for OUD are affected by environmental, economic, and system-level barriers, which include a lack of mental health providers, geographic misdistribution of substance use treatment facilities, income-related impediments, health care insurance gaps, and logistical issues related to the physical isolation of rural communities (Lister et al, 2020)…”

“…Yet significant disparities in substance abuse treatment persist nationally in rural areas. Rural individuals seeking treatment for OUD are affected by environmental, economic, and systemlevel barriers, which include a lack of mental health providers, geographic misdistribution of substance use treatment facilities, income-related impediments, health care insurance gaps, and logistical issues related to the physical isolation of rural communities (Lister et al, 2020) Medication-assisted treatment (MAT) is an evidencebased treatment for OUD that includes the use of medications combined with counseling and behavioral therapies (National Institute on Drug Abuse, 2016; Substance Abuse and Mental Health Services Administration, 2016; World Health Organization, 2017). MAT includes three Food and Drug Administration (FDA)-approved pharmacotherapies: buprenorphine, methadone, and naltrexone.…”

“Caballo”: risk environments, drug sharing and the emergence of a hepatitis C virus epidemic among people who inject drugs in Puerto Rico

“…Examining the social context in which PWID use drugs and make decisions about risk is critical for the successful adoption of harm reduction strategies to reduce HCV [65][66][67][68]. While harm reduction policies that emphasize the distribution of injection equipment are a valuable component in syringe exchange programs, findings suggest that preventing the sharing drug preparation equipment while sharing drugs might be more complex that behavioral health models suggests [69].…”