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Recently, news stories have focused on how addiction is ravaging families and communities, particularly in rural areas. Around one in five Americans lives in a rural area, defined as a community with fewer than 2,500 people. Rural and urban communities both face the challenges of substance use, overdose, and the opioid epidemic. Although substance use rates in rural areas have kept pace with those in urban areas, rural communities seem to have been hit harder. For example, a recent statistic shows a greater increase in the proportion of babies born addicted to opioids in rural communities than in urban areas.
Why do rural communities seem to be disproportionately affected by addiction?
Rural communities have been especially affected in the past few years by rising rates of poverty and unemployment, two key community-level risk factors for addiction. Getting treatment for addiction in rural communities is also much harder than in urban areas. There is limited access to medications that help treat addiction in rural areas because of stigma, misunderstanding, and a lack of accessibility, including a dearth of medical professionals available to prescribe and administer them. Greater access to medications like buprenorphine and methadone would have a huge impact on reducing opioid addiction and overdoses in rural areas where there has been an increase in overdoses and where the rates of overdose deaths are now higher than in urban communities.
It is not difficult to imagine the hardships presented in rural communities. Your friend or family member struggles with an addiction to prescription pain pills and she wants help, but the nearest treatment facility is over an hour away – and she has no car. Or your neighbor is addicted to heroin and can’t get the medication he needs because there is no methadone clinic in their county or nearby doctor to prescribe buprenorphine. These are barriers people in rural communities disproportionately face relative to those in urban areas when it comes to addiction treatment services.
Change is underway
Local law enforcement agencies have been key players in helping to address addiction in rural communities. Many police officers carry the opioid overdose reversal drug naloxone (Narcan) and work with medical personnel to provide information and referrals to services instead of pursuing criminal charges.
Rural communities are also finding new ways to address the lack of access to treatment. Some healthcare providers in rural areas are trying telemedicine – having patients consult with an addiction specialist via telephone or online during their appointments, so they can benefit from the expertise of a professional who isn’t immediately available in their vicinity.
The future of addiction treatment in rural areas
Some steps have already been taken to improve addiction treatment in these communities. The 21st Century Cures Act, which was recently passed by the federal government, includes funding to help states tackle the opioid epidemic. The Affordable Care Act (ACA), also known as Obamacare, has allowed more people to get insurance coverage and required insurance companies to cover addiction and mental health services on par with their plans’ medical and surgical health benefits. States that opted into the Medicaid expansion option of the ACA were able to provide health insurance to more of their residents.
Yet given the precarious future of the ACA under the new administration, it will be important to advocate for addiction treatment and coverage in rural areas, and to use existing resources efficiently and effectively.
Alexis is a Research Associate at Center on Addiction