A few days ago, we talked about the origins of the opioid crisis, and how dramatically it took root in rural communities.

But the opioid crisis didn't explode merely because addiction spreads quickly in small towns; barriers to essential care also allowed the epidemic to fester and deepen its hold.

The nature of this disease requires treatment and support as soon as possible and both need to be sustained over the long haul, but right now, 77% of all rural counties are designated as "healthcare deserts" – meaning there is a serious shortage of primary care physicians within a reasonable distance.

In fact, rural areas see barriers in nearly every aspect of substance use treatment: availability and access, wait times, costs and reimbursements, distance to care, nearby community resources, and ongoing outpatient support.

Nearly 200 rural hospitals have closed since 2005, and another 600 nationwide are currently at risk of closing. At the same time, 35% of rural counties have a "high need" for opioid addiction treatment, but nearly 75% of them have low-to-no prescribing capacity for common Medication Assisted Treatments, such as buprenorphine.

Patients in crisis simply cannot wait weeks to begin care, but some federal rules make those waits unavoidable – and unacceptable. In-person visits are required in order to be treated with certain types of medications, discouraging patients from seeking treatment and increasing wait times, leaving folks unable to get assessed and receive initial treatment immediately.

When a doctor does become available, telehealth appointments aren't always helpful in rural areas because of patient houselessness, technology literacy, and lack of broadband internet. And some rural doctors are reluctant to offer highly effective medication treatments in favor of less effective abstinence treatments because of stigma, concerns about Medicaid reimbursement, lack of specialized training, and limited ability to monitor patients.

While there has been some real progress against this disease over the past two decades, it comes back to the systemic issues – things as simple as lack of health insurance or coverage for substance abuse treatment, closed hospitals, and a shortage of doctors that ultimately increase the fatal overdose rate, now projected to hit 1.2 million by the end of this decade.

For right now, the state of the opioid crisis in rural America is bleak and will take sustained, coordinated action from our leaders at the federal level to make sure rural communities have every possible resource at their disposal to fight this epidemic.

Tessa

Tessa Gould
One Country Project

Founded by former U.S. Senator Heidi Heitkamp (D-ND), the One Country Project is dedicated to reopening the dialogue with rural communities, rebuilding trust and respect, and advancing an opportunity agenda for rural Americans. Our mission is to ensure rural America’s priorities and values are heard, understood, well-represented and reflected in policy in Washington.

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