Abstract
The opioid overdose epidemic has significantly impacted rural communities. Rural settings present unique challenges to addressing opioid misuse. The purpose of the current study was to understand the similarities and differences between rural and urban-based providers serving rural communities. Washington state-based opioid-related service providers who serve rural communities (N = 75) completed an online survey between July and September 2020. Chi-square tests of association were used to examine significant differences in proportions between rural providers and rural-serving urban providers across opioid prevention, treatment, and recovery training topics. Rural providers reported receiving significantly less opioid treatment and recovery training on the criminal legal system, workplace-based education on treatment and recovery, and co-occurring disorder treatment; and significantly higher prior opioid prevention training on the prevention programs for youth and accessing prevention funding. Differences between rural and rural-serving urban providers demonstrate ways in which rural–urban partnerships can be strengthened to enhance public health.
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References
Alcohol and Drug Abuse Institute. (2023). Opioid trends across Washington state. https://adai.washington.edu/WAdata/deaths.htm#overallTimeTrends
Andrilla, C. H. A., Moore, T. E., Patterson, D. G., & Larson, E. H. (2019). Geographic distribution of providers with a DEA waiver to prescribe buprenorphine for the treatment of opioid use disorder: A 5-year update. The Journal of Rural Health, 35(1), 108–112. https://doi.org/10.1111/jrh.12307
Brooklyn, J. R., & Sigmon, S. C. (2017). Vermont hub-and-spoke model of care for opioid use disorder: Development, implementation, and impact. Journal of Addiction Medicine, 11(4), 286–292. https://doi.org/10.1097/ADM.0000000000000310
Carter, W. M., Morse, W. C., Brock, R. W., & Struempler, B. (2019). Improving physical activity and outdoor recreation in rural alabama through community coalitions. Preventing Chronic Disease, 16, E116. https://doi.org/10.5888/pcd16.190062
CDC, National Center for Health Statistics, Office of Communication. (2022). U.S. Overdose deaths in 2021 increased half as much as in 2020—But are still up 15%. National Center for Health Statistics.
Cheetham, A., Picco, L., Barnett, A., Lubman, D. I., & Nielsen, S. (2022). The impact of stigma on people with opioid use disorder, opioid treatment, and policy. Substance Abuse and Rehabilitation, 13, 1–12. https://doi.org/10.2147/SAR.S304566
Coronavirus Disease 2019. (2020). Centers for Disease Control and Prevention. https://www.cdc.gov/media/releases/2020/p1218-overdose-deaths-covid-19.html
Dillman, D. A., Smyth, J. D., & Christian, L. M. (2014). Internet, Phone, Mail, and Mixed-Mode Surveys: The Tailored Design Method. Wiley.
Faulkner, K. K., & Faulkner, T. A. (1997). Managing multiple relationships in rural communities: Neutrality and boundary violations. Clinical Psychology: Science and Practice, 4(3), 225–234. https://doi.org/10.1111/j.1468-2850.1997.tb00111.x
Fink, A., Kosecoff, J., Chassin, M., & Brook, R. H. (1984). Consensus methods: Characteristics and guidelines for use. American Journal of Public Health, 74(9), 979–983. https://doi.org/10.2105/AJPH.74.9.979
Gale, J., Hansen, A. Y., & Williamson, M. E. (2017). Rural Opioid Prevention and Treatment Strategies: The Experience in Four States [Policy Brief]. Mental Health/Substance Use Disorders. https://digitalcommons.usm.maine.edu/behavioral_health/28
Jones, C. M., & McCance-Katz, E. F. (2019). Co-occurring substance use and mental disorders among adults with opioid use disorder. Drug and Alcohol Dependence, 197, 78–82. https://doi.org/10.1016/j.drugalcdep.2018.12.030
Katz, J., & Wandersman, A. (2016). Technical assistance to enhance prevention capacity: A research synthesis of the evidence base. Prevention Science, 17(4), 417–428. https://doi.org/10.1007/s11121-016-0636-5
Koh, H. K. (2017). Community-based prevention and strategies for the opioid crisis. JAMA, 318(11), 993–994. https://doi.org/10.1001/jama.2017.13767
Kuehn, B. M. (2021). Accelerated overdose deaths linked With COVID-19. JAMA, 325(6), 523. https://doi.org/10.1001/jama.2021.0074
Levit, L. A., Byatt, L., Lyss, A. P., Paskett, E. D., Levit, K., Kirkwood, K., Schenkel, C., & Schilsky, R. L. (2020). Closing the Rural cancer care gap: Three Institutional approaches. JCO Oncology Practice, 16(7), 422–430. https://doi.org/10.1200/OP.20.00174
Marcin, J. P., Shaikh, U., & Steinhorn, R. H. (2016). Addressing health disparities in rural communities using telehealth. Pediatric Research, 79(1), 1. https://doi.org/10.1038/pr.2015.192
Monnat, S. M. (2020). Opioid crisis in the rural U.S. In J. E. Glick, S. M. McHale, & V. King (Eds.), Rural families and communities in the United States: Facing challenges and leveraging opportunities (pp. 117–143). Springer International Publishing. https://doi.org/10.1007/978-3-030-37689-5_5
Olsen, Y., & Sharfstein, J. M. (2014). Confronting the stigma of opioid use disorder—And its treatment. JAMA, 311(14), 1393–1394. https://doi.org/10.1001/jama.2014.2147
Palombi, L., Olivarez, M., Bennett, L., & Hawthorne, A. N. (2019). Community forums to address the opioid crisis: An effective grassroots approach to rural community engagement. Substance Abuse: Research and Treatment, 13, 1178221819827595. https://doi.org/10.1177/1178221819827595
Palombi, L. C., St Hill, C. A., Lipsky, M. S., Swanoski, M. T., & Lutfiyya, M. N. (2018). A scoping review of opioid misuse in the rural United States. Annals of Epidemiology, 28(9), 641–652. https://doi.org/10.1016/j.annepidem.2018.05.008
Richard A. Rawson. (2017). Vermont Hub-and-spoke model of care for opioid use disorders: An evaluation. (p. 185). Vermont Center on Behavior & Health. https://www.healthvermont.gov/sites/default/files/documents/pdf/ADAP_Hub_and_Spoke_Evaluation_2017_1.pdf
Reif, S., Brolin, M. F., Stewart, M. T., Fuchs, T. J., Speaker, E., & Mazel, S. B. (2020). The Washington State Hub and Spoke Model to increase access to medication treatment for opioid use disorders. Journal of Substance Abuse Treatment, 108, 33–39. https://doi.org/10.1016/j.jsat.2019.07.007
Rhodes, T. (2002). The “risk environment”: A framework for understanding and reducing drug-related harm. International Journal of Drug Policy, 13(2), 85–94. https://doi.org/10.1016/S0955-3959(02)00007-5
Substance Abuse and Mental Health Services Administration. (2023). Rural Opioid Technical Assistance (ROTA). https://www.samhsa.gov/rural-opioid-technical-assistance-rota
Swann, W. L., Kim, S., Kim, S. Y., & Schreiber, T. L. (2021). Urban-rural disparities in opioid use disorder prevention and response activities: A cross-sectional analysis. The Journal of Rural Health, 37(1), 16–22. https://doi.org/10.1111/jrh.12491
The American Association for Public Opinion Research. (2016). Standard Definitions: Final Dispositions of Case Codes and Outcome Rates for Surveys (9th ed., p. 81). AAPOR.
Wandersman, A., Chien, V. H., & Katz, J. (2012). Toward an evidence-based system for innovation support for implementing innovations with quality: Tools, training, technical assistance, and quality assurance/quality improvement. American Journal of Community Psychology, 50(3–4), 445–459. https://doi.org/10.1007/s10464-012-9509-7
Whitacre, B. E., & Mills, B. F. (2007). Infrastructure and the Rural—Urban divide in high-speed residential internet access. International Regional Science Review, 30(3), 249–273. https://doi.org/10.1177/0160017607301606
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The contents of this paper were developed with the assistance of a grant from the Substance Abuse and Mental Health Services Administration/Center for Substance Abuse Treatment (SAMHSA/CSAT; Grant # H79 TI092557; McDonell, Webright, Co-PIs). However, the contents do not necessarily represent the policy of the U.S. Department of Health and Human Services, and endorsement by the Federal government should not be assumed.
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All authors contributed to conceptualization of the study. DLW, KH, and LSK: led the analysis. All of the authors contributed to interpreting the results and drafting the article. LSK, EW, MM, LH, JR, and MM: contributed to conceptualization of the project. EW and MM: contributed to funding acquisition.
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Kriegel, L.S., Hampilos, K., Weybright, E. et al. Addressing the Spectrum of Opioid Misuse Prevention, Treatment, and Recovery in Rural Washington State Communities: Provider Identified Barriers and Needs. Community Ment Health J 60, 600–607 (2024). https://doi.org/10.1007/s10597-023-01215-w
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DOI: https://doi.org/10.1007/s10597-023-01215-w