Assessing Differences in the Availability of Opioid Addiction Therapy Options: Rural Versus Urban and American Indian Reservation Versus Nonreservation

Abstract

Background Opioid misuse is a large public health problem in the United States. Residents of rural areas and American Indian (AI) reservation/trust lands represent traditionally underserved populations with regard to substance-use-disorder therapy. Purpose Assess differences in the number of opioid agonist therapy (OAT) facilities and physicians with Drug Addiction Treatment Act (DATA) waivers for rural versus urban, and AI reservation/trust land versus non-AI reservation/trust land areas in Washington State. Methods The unit of analysis was the zip code. The dependent variables were the number of OAT facilities and DATA-waivered physicians in a region per 10,000 residents aged 18–64 in a zip code. A region was defined as a zip code and its contiguous zip codes. The independent variables were binary measures of whether a zip code was classified as rural versus urban, or AI reservation/trust land versus non-AI reservation/trust land. Zero-inflated negative binomial regressions with robust standard errors were estimated. Results The number of OAT clinics in a region per 10,000 zip-code residents was significantly lower in rural versus urban areas (P = .002). This did not differ significantly between AI reservation/trust land and non-AI reservation/trust land areas (P = .79). DATA-waivered physicians in a region per 10,000 zip-code residents was not significantly different between rural and urban (P = .08), or AI reservation/trust land versus non-AI reservation/trust land areas (P = .21). Conclusions It appears that the potential for Washington State residents of rural and AI reservation areas to receive OAT is similar to that of residents outside of those areas; however, difficulties in accessing therapy may remain, highlighting the importance of expanding health care insurance and providing support for DATA-waivered physicians.

Opioid Overdose Experience, Risk Behaviors, and Knowledge in Drug Users from a Rural Versus an Urban Setting

“…First, opioid users in rural settings are more likely to abuse prescription opioids (versus heroin) relative to those in urban settings (Cicero, Surratt, Inciardi, & Munoz, 2007; Rigg & Monnat, 2015; Wang, Becker, & Fiellin, 2013; Wang, Fiellin, & Becker, 2014). Second, relative to urban settings, rural settings have substantially lower availability for opioid use disorder treatments (Heil, Sigmon, Jones, & Wagner, 2008; Hirchak & Murphy, 2016; Paulozzi & Xi, 2008; Paulozzi & Xi, 2008; Rosenblum et al, 2011; Rosenblum et al, 2011; Stein et al, 2015; Stein et al, 2015), which could otherwise serve as a protective factor against opioid overdose (Schwartz et al, 2013). For instance, 90.4% of physicians who are authorized to prescribe buprenorphine reside in metropolitan areas versus 1.3% who reside in rural settings, and 82.5% of rural counties have no buprenorphine-authorized physician (Rosenblatt, Andrilla, Catlin, & Larson, 2015).…”

Transgenic increase in the β‐endorphin concentration in cerebrospinal fluid alleviates morphine‐primed relapse behavior through the μ opioid receptor in rats

“…Continual relapse due to physical and psychological dependence is the primary cause of detoxification failure. Thus, exploring optimal therapies for opioid relapse is a worldwide challenge . Although current strategies to prevent opioid relapse have improved through multidisciplinary endeavors, the relapse rate after opioid detoxification is still high and ranges from 72% to 88% after 12 to 36 months, as indicated by an epidemiological investigation …”

“…Thus, exploring optimal therapies for opioid relapse is a worldwide challenge. 7,8 Although current strategies to prevent opioid relapse have improved through multidisciplinary endeavors, the relapse rate after opioid detoxification is still high and ranges from 72% to 88% after 12 to 36 months, as indicated by an epidemiological investigation. 9 Prolonged neuroendocrine system dysfunctions in opioid addicts play a role in protracted withdrawal symptoms and contribute to relapse vulnerability.…”

Medication‐Assisted Opioid Treatment Prescribers in Federally Qualified Health Centers: Capacity Lags in Rural Areas

“…Previous research indicates that many buprenorphine providers are located in urban areas, and rural areas have fewer substance use disorder treatment facilities that accept Medicaid . One study in Washington State did not find urban/rural differences in the ratio of DEA‐waivered providers to patients …”

“…20 One study in Washington State did not find urban/rural differences in the ratio of DEA-waivered providers to patients. 21 Until recently, treatment for substance use disorders was traditionally delivered outside the primary care setting, mostly in specialty substance use disorder settings. Substance use disorder treatment is becoming more accessible in ambulatory settings, 22 and to the primary care context in particular.…”