Rural Ohioans still need more drug treatment
Maheen Nadeem | Policy Matters Intern
Every Ohioan deserves to get medical treatment – whether it’s for COVID-19 or for substance use disorder – and whether they live in the city, the suburbs or rural communities. The COVID-19 pandemic has demonstrated the way good public health policy can save lives. Gov. DeWine’s aggressive early response helped curb the state’s outbreak. Just a few years ago, state leaders took important steps to tackle the opioid crisis by increasing support for evidence based treatment. Yet people with addiction who live in rural communities have a more difficult time getting it.
In 2017, President Trump declared the opioid crisis a national emergency. That same year, Ohio had the nation’s second highest rate of drug overdose deaths. Since then, many experts have encouraged medication and counselling for Ohioans dealing with addiction. Medication-Assisted Treatment (MAT) services, including the distribution of buprenorphine, naltrexone, and methadone, have shown a considerable reduction in opioid use disorder-related (OUD) symptoms, especially in Ohio’s metropolitan areas.
However, people in Ohio’s rural communities aren’t receiving this important treatment at the same rates. Estimates suggest that only 20 to 40% of Ohioans struggling with an opioid addiction disorder can get treatment because there are too few providers and they’re spread too far apart. To expand treatment capacity in rural Ohio, state lawmakers need to consider and implement successful strategies used by other states.
For example, Vermont and New Mexico lead the country when it comes to creating a network to help at-risk patients from rural areas who require treatment but lack the necessary transportation. Vermont uses the hub-and-spoke model, a system that connects large intensive medical centers – hubs - to smaller treatment facilities – spokes - often in physician’s offices. Nine large hubs providing high intensity MAT services are connected to over 75 spokes that provide less intensive, ongoing treatment across the state. Spokes are dispersed throughout various communities, offering a more convenient setting for patients in rural areas. Not only did this model reduce health care costs for people who received MAT compared to those who didn’t, it also eliminated treatment waitlists. Vermont then achieved the nation’s highest opioid treatment capacity in the country, per capita, in 2017. A year later, overdose-related deaths decreased by 50% in the state’s largest county.
For over 15 years, New Mexico’s Project Echo has addressed the state’s opioid addiction problem by training caregivers in rural primary care centers via telementoring. Teams of specialists regularly communicate with primary care physicians on the frontlines. Per capita, the state now has the fourth-highest number of buprenorphine-waivered physicians in the country. Telementoring has helped build the capacity of local providers to treat other chronic diseases in New Mexico as well. Even in the current moment, which calls for physical distancing to limit the spread of COVID-19, telehealth has become an important strategy to ensure people have access to behavioral health care. Overall, both states have altered the landscape of the opioid crisis in their respective regions via increased accessibility to MAT services.
“Diseases of despair,” such as depression and substance abuse disorder, are linked to financial insecurity. Ohioans without college degrees, who are paid low wages, or who have been laid off are at greater risk for depression and addiction.
Between 2015 and 2019, prescriptions for naloxone, which is used to treat opioid overdoses, rose by 18% in Ohio counties with low employment rates. Another study demonstrated a clear connection between manufacturing plant closures and an increase in opioid overdose deaths. People of color have also been more likely to die of opioid substance abuse than white people. It’s something policymakers and public health experts should watch even more closely now: Since the onset of the COVID-19 pandemic in Ohio, more than 1.1 million Ohioans have filed for unemployment compensation. Many of them were paid low wages to begin with.
The COVID-19 pandemic is already taking a toll. Cases of addiction and overdose deaths have spiked in Central Ohio. Social isolation can exacerbate mental health issues like depression, posing greater risk for addiction. Now more than ever, Ohio policymakers need to expand treatment by targeting those struggling in rural parts of the state.
Over the long term, our leaders need to build healthier communities for everyone – no matter where they live or what they look like. They can do that by fully funding public education, raising the minimum wage, and increasing our investment in community behavioral health services.