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Giving Compass' Take:
• National Rural Health Association discusses current policy barriers to treating the opioid epidemic and how policy can be structured to best address the issue.
• What policy actors are ready to move on this issue? What opportunities for public-private partnerships exist?
• Find out how impact investors can help stop the opioid epidemic.
Treatment of opioid use disorders is necessary to return dependent patients to normal functioning and quality of life, and to avoid the many major complications of opioid dependence including trauma, suicide, HIV and Hepatitis C infection and early death. Mortality in these patients is increased by a factor of twenty. Furthermore, increasing access to treatment has been shown to decrease rates of overdose deaths, infectious disease transmission rates, and engagement in criminal activity, and to improve retention in treatment and social functioning.
However, while treatment is clearly needed and effective, there are many barriers to its provision. Education about treatment of pain and addiction is very limited in US medical schools, occupying 0.3% of the formal curriculum on average, and leaving graduates underprepared and lacking in confidence when treating patients with these issues. In addition, physicians must obtain a waiver under the Drug Addiction Treatment Act (DATA) in order to prescribe the most common medication used for outpatient treatment, buprenorphine16, but only 2.2 % of practicing US physicians are approved to use it. Of these physicians, 90% practice in urban counties, leaving 53% of rural counties without any prescribing physician and 30 million people living in counties where treatment is unavailable. Rural providers who are able to prescribe buprenorphine report a demand far beyond their capacity18 and that they lack the resources to adequately support themselves and patients in treatment. Additionally, wait times for treatment are prolonged, particularly in rural areas.
Given the challenges discussed above, the National Rural Health Association supports the following policies in order to address and reverse the current nationwide opioid epidemic that has hit hardest in vulnerable rural communities.
- Make MAT (buprenorphine or methadone) an option in all rural communities by removing barriers to treatment.
- Improve the availability of MAT prescribers, chemical dependency professionals and mental health professionals in rural areas.
- Improve availability of outpatient mental health, recovery, and peer recovery services in rural settings.
- Improve availability of inpatient facilities that treat substance use disorders.
- Make Naloxone available to every patient suffering from an opiate use disorder and to concerned friends, loved ones and other bystanders who have been properly trained in its use.
- Provide funding for research on treatment of opioid issues specifically in rural settings to better document what works in these environments and develop innovative solutions to this burgeoning problem.
As a result of rising rates of opioid use disorders, drug overdoses are now the number one cause of accidental deaths in Americans with an estimated 47,055 deaths in 2014 alone, exceeding the death rate from automobile accidents. Additionally, the rate at which heroin and fentanl are abused increased along with the rate of prescription opiate abuse. This implies a disturbing trend of tolerance to prescription opioids leading to the substitution of heroin in its stead.