Opioid Abuse Treatment: Navigating the Challenges of Treating Underserved Populations – Thought Leadership

Opioid Abuse Treatment: Navigating the Challenges of Treating Underserved Populations

by Micah Hoffman, MD, DABPN, FAPA

AllMed Behavioral Health Medical Director

While gaps in capacity to treat opioid use disorder exist across the United States, they disproportionately affect rural populations and those with unstable housing. For both groups, unique socioeconomic vulnerabilities and healthcare challenges create barriers to treatment not often experienced by more economically advantaged urban populations. The barriers pose unique challenges for healthcare organizations as they work to support these populations optimally, in a manner that aligns with plan policies. Coordinating care among providers who work directly with members, board-certified psychiatrists and psychologists, and health plans can help stretch limited resources to serve these underserved groups most effectively.

Rural Communities Face Unique Challenges

Over 42 million people live in non-metropolitan communities in the U.S.¹ These rural communities have been hit particularly hard by increasing drug use. Drug overdose deaths increased 325 percent in rural counties between 1999 and 2015, at which point they surpassed the death rate in urban areas.² Nonfatal prescription opioid overdoses also are concentrated in states with large rural populations.³ A number of difficulties have combined to fuel this rise, including⁴:

• Scarcity of Resources – Rural communities often lack specialized services. As a stark example, according to the Substance Abuse and Mental Health Services Administration (SAMHSA), South Dakota has just one opioid treatment program while Idaho, Montana and Nebraska have four each.⁵ Together, these four states have 13 treatment centers to support a population of nearly 5.9 million individuals.
• Limited Accessibility – People who live in rural areas typically are geographically dispersed and may have to travel long distances to services. The 13 treatment centers mentioned above cover a geographic area of approximately 385,000 square miles.
• Stigma – Because there are so few treatment programs available to citizens in many rural communities, it may be difficult to maintain anonymity. This makes it less likely that people will seek treatment.
• Inadequate Funding – If the program cannot offer professionals a competitive salary, they will not be able to recruit and retain competent personnel.
• Bias against medication assisted treatment (MAT) – Despite research indicating that it supports long-term recovery, some in the treatment field and throughout society believe that MAT is trading one drug for another. According to SAMHSA, MAT is greatly underused generally, and particularly in rural areas, where the prevailing belief may be that abstinence is the only way to overcome an addiction and enter long-term recovery.⁶

Housing Instability Complicates Treatment

Like their rural counterparts, individuals with opioid use disorder who lack stable housing face formidable barriers to obtaining treatment. Partially as a result, they face overdose death rates 30 times higher than the general population.⁷ Innovative methods such as provision of MAT within harm reduction agencies, mobile methadone vans, and buprenorphine prescribing by street medicine teams have been deployed and demonstrate the ability to reach these populations, but regular follow-up can be a challenge.⁸

As opioid use continues to affect growing numbers of people, MAT has become a crucial tool to help individuals suffering from opioid use disorder. However, several factors are slowing adoption.

The first is that, by federal law, a healthcare professional must obtain a waiver to administer these medications. To qualify for the waiver, a provider must complete eight hours of required training. A second, and perhaps more significant, factor is that even after providers obtain the waiver and are able to prescribe buprenorphine, some report that they don’t feel confident enough in their knowledge to treat opioid use disorder patients in a primary care setting. As overwhelming as identifying a treatment plan can be for providers, it is, of course, much more so for members and their families, who often are unfamiliar with the healthcare system and feel helpless.

Partnering to Optimize Resources

This is where AllMed can play a key role as an extension of your team. Our board-certified psychiatrists and psychologists can guide providers treating opioid use disorder in remote locations and in difficult circumstances. Drawing on extensive clinical experience, our specialists will support your team with the knowledge to be able to balance individual member needs with the limited resources available geographically and under the plan. Collaborating with AllMed can provide your team with the tools to determine the most appropriate way forward for opioid use treatment.