The study correlated the location of opioid treatment programs with opioid-related deaths. Surprisingly, the existence of an opioid treatment program was not found to be associated with lower numbers of opioid-related deaths. (Graphic, courtesy of the authors)

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The opioid epidemic has been especially prevalent in rural areas across the country over the past decade. One issue that makes the opioid problem worse in these communities is the lack of access to effective treatment options. 

The Centers for Disease Control and Prevention (CDC) recommended treatment plan for someone looking to end their opioid misuse is medicated-assisted treatment (MAT). A MAT program uses medications to curb opioid cravings along with behavioral therapies. Opioid treatment programs (OTPs) provide medicated-assisted treatment and are located in either outpatient, residential, or hospital settings. Opioid treatment programs typically combine medication treatment with services for primary and mental healthcare. 

Historically, rural areas lack medicated-assisted treatment programs and opioid treatment facilities in their communities. This shortage leads to longer travel times to and from treatment for rural patients, which can be problematic for those without a reliable means of transportation. 

This new study examines if having an opioid treatment program nearby is associated with lower county-level opioid-related death rates. It uses data from all counties in the South census region (which includes 16 states and the District of Columbia) – and leads all census regions in terms of drug overdose deaths. The figure below shows the dramatic rise in opioid-related deaths for this region. 

The study uses data from several different sources. Opioid-related death rates come from the CDC multiple cause-of-death mortality files. The National Directory of Drug and Alcohol Treatment Facilities is used to determine where opioid treatment programs are located across the South. Finally, other variables that may influence overdose rates (poverty rates, racial composition, opioid prescription rates) come from the CDC’s U.S. Opioid Prescribing Rate Maps and the U.S. Census American Community Survey.  The map at the top of this article demonstrates that 286 of the 314 OTPs (91%) in the South were in metropolitan counties as of 2013 – and that many nonmetro counties did not have a nearby opioid treatment program option. 

The analysis considers two distinct situations:  (1) if a rural county had an opioid treatment program as of 2013, and (2) a neighboring county had an opioid treatment program as of 2013. Then, a statistical technique is used to match “treated” counties (i.e. with access to an opioid treatment program) to otherwise similar counties that did not have access. The two groups of counties are then compared in terms of opioid-related deaths after the treatment programs became available (2014 to 2016).

The results were somewhat surprising. The presence of an opioid treatment program was not found to be associated with lower numbers of opioid-related deaths in later years. This result holds for both the rural and urban counties in the South. 

There are many possible reasons why this result may hold. An important one is that the study only focused on opioid-related deaths as the outcome of interest. It is possible (and likely) that opioid treatment programs are associated with lower rates of opioid addictions and relapses – however, these outcomes are more difficult to measure.  Alternatively, societal factors in rural communities could also interfere with the lack of association between opioid treatment programs and opioid deaths. The stigma associated with attending treatment is a concern for rural patients, who often come from close-knit communities.

Identifying the health-related outcomes associated with opioid treatment is important, especially in rural areas where these options are scarce. This study is a first step in understanding rural opioid treatment programs and raises new questions about potential factors that could limit their effectiveness.

Devon Meadowcroft is a postdoctoral researcher at the Northeast Regional Center for Rural Development and Brian Whitacre is a Sarkeys Distinguished Professor at Oklahoma State University.  Their study was recently published in Substance Use & Misuse and is entitled “Are Rural Opioid Treatment Program (OTP) Facilities Associated with Lower Deaths?”