Urban‐Rural Disparities in Opioid Use Disorder Prevention and Response Activities: A Cross‐Sectional Analysis

Swann, William L.; Kim, Sojeong; Kim, Serena; Schreiber, Terri L.

doi:10.1111/jrh.12491

Cited by 21 publications

(19 citation statements)

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“…9 Many reported barriers to treatment are magnified in rural communities and primary care. 10,11 Clinicians, practices, and community members affiliated with the High Plains Research Network (HPRN) and the Colorado Research Network (CaReNet) identified opioid dependence as a primary concern in their communities. As the research team visited practices, clinicians and practice staff described their concerns about over-prescribing, drug diversion, potential for addiction, and the severe lack of local treatment.…”

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confidence: 99%

Increasing Capacity for Treatment of Opioid Use Disorder in Rural Primary Care Practices

et al. 2022

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PURPOSE Evidence supports treatment for opioid use disorder (OUD) with buprenorphine in primary care practices (PCPs). Barriers that slow implementation of this treatment include inadequately trained staff. This study aimed to increase the number of rural PCPs providing OUD treatment with buprenorphine. This evaluation describes the impact of a practice team training on the implementation and delivery of OUD treatment with buprenorphine in PCPs of rural Colorado. METHODS Implementing Technology and Medication Assisted Treatment Team Training inRural Colorado (IT MATTTRs) was a multilevel implementation study that included a practice-focused intervention to improve awareness, adoption, and use of buprenorphine treatment for OUD. Participating PCP teams received the IT MATTTRs Practice Team Training and support. Practices' implementation of treatment components was assessed before and after training. Practice-reported and population-level data from the Prescription Drug Monitoring Program were obtained to describe changes in delivery of treatment after training. RESULTSForty-two practices received team training. Practices reported an average of 4.7 treatment-related components in place at baseline compared with 13.0 at 12-month follow-up (F[2,56] = 31.17, P <.001). The proportion of participating practices providing or referring patients for treatment increased from 18.8% to 74.4%. The increase in number of people with a prescription for buprenorphine was significantly greater in the study region over a 4-year period compared with the rest of the state (Wald χ 2 = 15.73, P <.001). CONCLUSIONSThe IT MATTTRs training for PCP teams in OUD treatment with buprenorphine addressed elements beyond clinician waiver training to make implementation feasible and effectively increased implementation and delivery of this treatment in rural Colorado.

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confidence: 99%

Increasing Capacity for Treatment of Opioid Use Disorder in Rural Primary Care Practices

et al. 2022

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“…16 While policy reform is needed at all levels of government to expand access to MOUD and other evidence-based practices, local governments and their health departments can play an active role in opioid response implementation. 17,18 Since the opioid epidemic was declared a national emergency in 2017, about two-thirds (65%) of local health departments (LHDs) reported conducting activities to address opioid use and abuse. 19 However, the cross-jurisdictional and cross-sector scale and complexity of the opioid epidemic hinder any government or organization from adequately addressing the problem alone.…”

Section: Introductionmentioning

confidence: 99%

“…To date, no studies of which the authors are aware have examined this relationship. Accordingly, this study adds to the broader understanding of strategies used in community opioid response, [17][18][19][20][21] particularly in rural areas. [31][32][33] That local government engagement in collaboration related to greater capacity to provide methadone but not buprenorphine 46 Public administration research has long studied "publicness" or "a characteristic of an organization which reflects the extent the organization is influenced by political authority" that will, in turn, partly determine the extent to which public values are realized.…”

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confidence: 99%

“…While collaboration has been identified as an important strategy in rural opioid response, [31][32][33] limited evidence of its impact exists. Rural communities are smaller in terms of population and have shown lower rates of implementing some opioid response and prevention activities than their urban counterparts, 18 although this distinction did not appear in counties with high overdose mortality rates. 17 Thus, the marginal benefits to collaborating on opioid response could be higher for the average rural county than its urban counterpart.…”

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confidence: 99%

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Association Between Interorganizational Collaboration in Opioid Response and Treatment Capacity for Opioid Use Disorder in Counties of Five States: A Cross-Sectional Study

Swann

DiNardi

Schreiber³

2022

Subst�Abuse

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Background: Local governments on the front lines of the opioid epidemic often collaborate across organizations to achieve a more comprehensive opioid response. Collaboration is especially important in rural communities, which can lack capacity for addressing health crises, yet little is known about how local collaboration in opioid response relates to key outputs like treatment capacity. Purpose: This cross-sectional study examined the association between local governments’ interorganizational collaboration activity and agonist treatment capacity for opioid use disorder (OUD), and whether this association was stronger for rural than for metropolitan communities. Methods: Data on the location of facilities providing buprenorphine and methadone were merged with a 2019 survey of all 358 counties in 5 states (CO, NC, OH, PA, and WA) that inquired about their collaboration activity for opioid response. Regression analysis was used to estimate the effect of a collaboration activity index and its constituent items on the capacity to provide buprenorphine or methadone in a county and whether this differed by urbanicity. Results: A response rate of 47.8% yielded an analytic sample of n = 171 counties, including 77 metropolitan, 50 micropolitan, and 44 rural counties. Controlling for covariates, a 1-unit increase in the collaboration activity index was associated with 0.155 (95% CI = 0.005, 0.304) more methadone facilities, ie, opioid treatment programs (OTPs), per 100 000 population. An interaction model indicated this association was stronger for rural (average marginal effect = 0.354, 95% CI = 0.110, 0.599) than for non-rural counties. Separate models revealed intergovernmental data and information sharing, formal agreements, and organizational reforms were driving the above associations. Collaboration activity did not vary with the capacity to provide buprenorphine at non-OTP facilities. Spatial models used to account for spatial dependence occurring with OUD treatment capacity showed similar results. Conclusion: Rural communities may be able to leverage collaborations in opioid response to expand treatment capacity through OTPs.

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“…Accessibility issues are particularly pronounced in rural communities, where opioid prescribing rates are higher [2], and rates of opioid overdose death have increased dramatically [3]. While both urban and rural communities suffer from high rates of opioid prescription and overdose deaths [4], addressing OUD in rural areas is more difficult due to limited resources for prevention, treatment, and recovery [5], as well as lack of social networks and economic opportunity disadvantage [4]. Methadone has been shown to reduce the risk of opioid overdose and better aid in treatment retention compared to nonpharmacological treatments and supports alone [6].…”

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confidence: 99%

Cumulative barriers to retention in methadone treatment among adults from rural and small urban communities

Pasman

Kollin

Broman

et al. 2022

Addict Sci Clin Pract

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Background Though methadone has been shown to effectively treat opioid use disorder, many barriers prevent individuals from accessing and maintaining treatment. Barriers are prevalent in less populated areas where treatment options are limited. This study examines barriers to retention in methadone treatment in a small Midwest community and identifies factors associated with greater endorsement of barriers. Methods Patients at an opioid treatment program (N = 267) were recruited to complete a computer-based survey onsite. Surveys assessed demographics, opioid misuse, depression and anxiety symptoms, trauma history and symptoms, social support, and barriers to retention in treatment (e.g., childcare, work, housing, transportation, legal obligations, cost, health). Descriptive statistics were used to examine individual barriers and multiple regression was calculated to identify demographic and psychosocial factors associated with greater cumulative barriers. Results Most participants reported at least one barrier to retention in treatment and more than half reported multiple barriers. Travel hardships and work conflicts were the most highly endorsed barriers. Past year return to use (B = 2.31, p = 0.004) and more severe mental health symptomology (B = 0.20, p = 0.038) were associated with greater cumulative barriers. Greater levels of social support were associated with fewer barriers (B = − 0.23, p < 0.001). Conclusion This study adds to the limited research on barriers to retention in methadone treatment among patients in rural and small urban communities. Findings suggest flexible regulations for dispensing methadone, co-location or care coordination, and family or peer support programs may further reduce opioid use and related harms in small communities. Individuals with past year return to use reported a greater number of barriers, highlighting the time following return to use as critical for wraparound services and support. Those with co-occurring mental health issues may be vulnerable to poor treatment outcomes, as evidenced by greater endorsement of barriers. As social support emerged as a protective factor, efforts to strengthen informal support networks should be explored as adjunctive services to methadone treatment.

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Urban‐Rural Disparities in Opioid Use Disorder Prevention and Response Activities: A Cross‐Sectional Analysis

Abstract: for their insights, as well as Alex Osei-Kojo and Megan Lamiotte for their assistance with data acquisition.

Cited by 21 publications

References 11 publications

Increasing Capacity for Treatment of Opioid Use Disorder in Rural Primary Care Practices

Increasing Capacity for Treatment of Opioid Use Disorder in Rural Primary Care Practices

Association Between Interorganizational Collaboration in Opioid Response and Treatment Capacity for Opioid Use Disorder in Counties of Five States: A Cross-Sectional Study

Cumulative barriers to retention in methadone treatment among adults from rural and small urban communities

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