Challenges Faced by Rural Communities in Providing Addiction Treatment

A session at the recent virtual Rx Drug Abuse & Heroin Summit educated attendees about several resources available from the federal government to help rural communities overcome the challenges they face in accessing and providing treatment and recovery services for substance use disorder/opioid use disorder (SUD/OUD). 

In this Q&A, session presenter and moderator Betty-Ann Bryce, JD, MA, Special Advisor for Rural Affairs, Office of National Drug Control Policy, Washington, DC, discusses what those challenges are, governmental resources that have been developed, and post-pandemic measures needed to ensure access to SUD/OUD treatment in rural communities in the future.

Q: What unique challenges do rural communities face in providing treatment for SUD/OUD? 

A: Rural and tribal communities across the United States often lack many of the resources needed to keep people healthy and free from addiction, including critical assets like mental and behavioral health counselors, support groups, broadband internet access, and housing and transportation. Rural Americans also live farther away from emergency care, detox, and treatment options. The majority of Mental Health Professional Shortage Areas (MHPSAs) are in rural counties. More than 60% of rural Americans live in MHPSAs and more than 65% of rural Americans get their mental health care from a primary healthcare provider, and the mental health crisis responder for most rural Americans is a law enforcement officer.¹

Q: What are some strategies the federal government has used to help rural communities confront these challenges, and what results have you seen?

A: To help local leaders build an effective response, we have developed a number of tools.  Each of these tools are online and designed to be very user-friendly for a rural leader at the local level to use.

1. The Community Assessment Data Tool is an interactive data tool that helps community leaders assess how and why the opioid epidemic is impacting their regions. Many rural communities need assistance to even begin using data and information.  The tool was developed to help rural communities get started by providing county level data to help local leaders see the scope of the problem and identify its underlying causes.  The tool provides data about drug-related deaths and overlays it with information about socioeconomic factors such as education levels, disability rates, and unemployment, which contribute to local trends.

2. The Rural Community Action Guide is a report that covers 17 different topics related to addiction including stigma, housing, broadband, transportation, and the faith community—and for each topic it includes background information to inform local leaders and provide recommended actions. The material for each topic in the guide was written by contributing urban and rural experts.

3. The Rural Community Toolbox is a comprehensive directory of federal resources developed by the Rural Federal Interagency Working Group. While there are many federal programs to help rural areas, rural communities often find it overwhelming to navigate multiple federal websites. The toolbox was built to meet this need by providing a one-stop access point to federal funds available to help rural communities respond to the addiction crisis. It takes a community development approach, which is particularly relevant in rural communities.  In addition to prevention and treatment resources, it includes information on transportation, economic development, broadband infrastructure, access to food, and much more.

The resources have been well received and they are being used in diverse ways.  At the Rx Summit, in the Rural Resources session, the National Association of Drug Court Professionals pointed out that they have incorporated the tools in their training modules with treatment, veteran, and tribal courts.

Q: What post-pandemic measures are needed to ensure SUD treatment is readily available through telehealth in rural communities in the future?

A: Access to broadband internet and the ability to deliver virtual care has proved critical during the pandemic. Nonetheless, challenges remain in key areas to include accessing the infrastructure, accessing information whether you are a provider or a patient, as well as information on how to transition to virtual care.  In addition, research has shown that while telehealth has helped bridge communication gaps, allowed for the continuation of care, and reduced patient and clinician exposure to the coronavirus, some longstanding barriers must still be addressed to improve the effectiveness of telehealth.¹

We are encouraged by the steps taken by Centers for Medicare and Medicaid Services (CMS) to add 60 services to the Medicare telehealth list that will continue to be covered beyond the end of the COVID-19 Public Health Emergency (PHE). These services will allow beneficiaries in rural areas who are in a medical facility (like a nursing home) to continue to have access to telehealth services such as certain types of emergency department visits, therapy services, and critical care services.  The deliberate and robust actions taken by the Federal Communications Commission and the Department of Agriculture’s Rural Development Agency to increase rural access to broadband infrastructure and equipment during the pandemic was equally welcome. Finally, the introduction of the www.Telehealth.hhs.gov site by the Health Resources and Services Administration (HRSA), an agency of the US Department of Health and Human Services (HHS), was pivotal. This resource provides an opportunity for rural providers and patients to stay informed as it provides information for health care providers and patients about the latest federal efforts to support and promote telehealth.

Reference

1. Hirko KA, Kerver JM, Ford S, et al. Telehealth in response to the COVID-19 pandemic: implications for rural health disparities. Journal of the American Medical Informatics Association. 2020;27(11):1816-1818.