Treating the Opioid Crisis in Rural America


Opioid Crisis Plagues Rural America

Midwest BLOG – Addiction typically begins with a legitimate injury or pain that is then rectified by a dosage of painkillers provided by a physician. Once the patient has used the prescribed medications, they are often unintentionally addicted to the substances. When their supply ultimately diminishes, they begin controlling their withdrawal symptoms with a cheaper street opiate like heroin.

According to the CDC, opioid overdoses accounted for more than 33,000 deaths in 2015 and 56,000 in 2016. The United States holds only 5 percent of the world’s population but consumes over 80 percent of the world’s opioids according to NCBI. With numbers this high and this staggering, there is no denying it anymore: prescription drug abuse and addiction have reached epidemic proportions.

Facts About Opioid Crisis in Rural America

The rate of overdoses in rural America, as described by the CDC, has far surpassed the overdoses accounted for in urban America. Death rates for unintentional deaths like drug overdoses and vehicle crashes are 50 percent higher in rural areas than urban neighborhoods. From 1999 to 2015, the opioid death rates in rural areas among 18-25-year-olds have quadrupled.

Rural areas and the close-knit relationships that come with smaller populations provide a perfect storm for people to become addicted to opioids. Some researchers believe that economic, environmental, and social factors leave rural America at risk for addiction. After the 2008 recession, rural America didn’t recover quickly, losing jobs and population numbers. This is what ultimately left people in a situation conducive to using prescription opioids to self-medicate symptoms of distress related to economic and physical stress.

Due to specific jobs prevalent in rural cities like farming and manufacturing, these communities tend to have high injury rates. This leads to more pain and in turn more medication. Opioids have been a key part of rural doctors’ pain management tools for their patients. Jack Westfall, a physician/researcher at the University of Colorado, says that there is a lack of treatment options available in rural areas. Alternatives for pain treatment, like physical therapy or massage therapy, are either not available or not retained.

A study done by the University of Michigan found that the rate of babies born with opioid withdrawal symptoms is rising much faster in rural areas than in urban America. The researchers found that the rate of newborns in rural communities diagnosed with neonatal abstinence syndrome (a side effect of being born addicted to opioids) was nearly 80 percent higher than the rate of babies born drug addicted in urban parts of the country. The study says that from 2012-2013, rural infants accounted for 21 percent of all infants born drug addicted in the US.

Resources Available for Rural Addicts

Telemedicine, or telehealth, works to improve access to treatment by allowing patients to consult with their provider remotely through video conferencing. One study found that the more times a patient attended sessions via telemedicine technology, the more likely they were to stay on an opioid treatment plan. This type of meeting helped patients access their providers more regularly to discuss medical issues.

Telemedicine also presents particular obstacles, however. At this time, providers are required by law to see their patients for an initial in-person physical assessment before prescribing controlled medication like Suboxone, which is an opioid used to help wean people off of other illicit forms of the drug. This type of treatment allows addicts to avoid withdrawal symptoms while promoting long-term recovery. Medication-assisted drug treatment is limited in rural areas, which forces addicts to drive many hours to and from clinics to get medications. However, with the use of Suboxone and regular telemedicine sessions, addicts are getting clean.

Children have access to substance abuse counseling at a young age. Adolescents and teens are among the most vulnerable populations for drug abuse. Early intervention with substance abuse counseling has decreased opiate use by 45 percent in the last five years among school-aged children. With the help of teachers, administrators, and school counselors, they work together to ensure that students receive the education and tools they need to lead healthy lives.

Challenges of Patient Care to Rural Areas

There are many challenging aspects to treating rural patients. Distance away from treatment centers is one of the biggest. Since rural communities typically have smaller populations, there are often fewer treatment centers close by; it doesn’t make sense to build large hospitals in these communities financially, or logistically. Public transportation is typically lacking in rural areas, so people who need help with opioid addiction may not seek it out due to the distance and the travel inconveniences involved.

Another pressing issue for the treatment of addicts is that lack of nurses and physicians available with appropriate training. The general shortage of educated health care workers across America is magnified in rural areas where they have less access to a health care education system.  Even though the field of nursing is one of the fastest growing professions, there is still a large shortage of registered nurses. For example, in 2008 there were 2.6 million nursing jobs in the United States. Now there are 3.2 million nursing jobs with a shortage of 200,000 nurses. Many rural areas lack clinics with available drug treatment options, as well as a shortage of physicians who prescribe opioid alternative treatments.

Social stigmas and a lack of privacy are another challenge of opioid-based patient care in rural communities. Since the population numbers in rural communities are far lower than in urban communities, members of them are less likely to maintain an anonymity when seeking out health care services. Rural residents are more often concerned with privacy when seeking treatment for health concerns.

There is a multitude of factors that affect a person’s vulnerability to opioid addiction. Rural communities are more susceptible to abusing drugs due to their lack of physical proximity to treatment centers. However, as the ramifications of these addictions spread, there is bound to be more resources available to patients.


About Author

Brooke Faulkner is a mother of two and wilderness enthusiast. When she's not writing, she can usually be found zipping around the mountains on her ATV.

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