Access to Addiction Care is a Matter of Life and Death for Rural Ohioans

Combining community-driven approaches with telehealth can help to address the impact of substance use disorders in rural Ohio.

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In 2022, the drug overdose death rate in Ohio was 43.6 per 100,000 individuals, which is one of the highest in the nation. The Ohio Department of Health reports that fentanyl contributed to 81% of these overdose fatalities.

Substance misuse and addiction are often associated with urban settings, yet rural areas face their own unique challenges in combating these issues. In areas with limited mental health services, including many rural counties in Ohio, individuals may find themselves turning to substances as a way to cope with challenges. In some rural counties in Ohio, the drug overdose death rate has spiraled to higher than 100 per 100,000 individuals.

Barriers to treatment in rural communities

Accessing addiction treatment is more challenging in rural areas compared to urban settings. The shortage of providers and facilities, coupled with the expansive geographic coverage required of rural providers, makes it difficult for individuals to access timely and appropriate care. Additionally, the close-knit nature of rural communities may pose confidentiality concerns, contributing to the stigma of seeking help for substance use issues. At the same time, a prevalent culture of self-reliance within these communities may deter individuals from seeking assistance.

Pharmacy barriers exacerbate the issue, as many pharmacies in rural areas refrain from dispensing life-saving medications crucial for individuals living with substance use disorders (SUD). Moreover, in certain rural communities, the dual challenges of limited transportation and a scarcity of pharmacies further compound the obstacles.

Low-barrier telehealth care is effective for rural communities

Addressing SUD in rural Ohio requires tailored interventions that acknowledge the barriers and intricacies of rural life. In a recent advisory, the Substance Abuse and Mental Health Services Administration (SAMHSA) advocates for low-barrier care in underserved communities that eliminates treatment engagement preconditions like substance abstinence. In its advisory, SAMHSA also calls for more accessible settings like telehealth. Despite the remarkable retention rates seen in telehealth for SUD among patients in rural communities, many healthcare and community-based organizations remain unaware of or lack the knowledge to connect individuals in need with SUD telehealth providers.

A recent study conducted by Workit Health presents outcomes from the largest sample of rural patients receiving SUD telehealth treatment to date. Published in the journal Telemedicine and e-Health, the study offers evidence on the efficacy of telehealth in treating SUD among rural populations—particularly rural residents who are mainly covered by Medicaid. The findings indicate that after 6 months, 52% of participants remained engaged in telehealth-based care, with nearly all of these patients adhering to their treatment plans. These outcomes are similar to, if not better than, most outcomes observed in traditional in-person treatment settings, highlighting the effectiveness of telehealth in addressing SUD in rural areas, including rural areas with high populations of individuals enrolled in subsidized health plans.

Community-driven approaches are key

In addressing SUD in rural communities, it is imperative to recognize and mitigate the unique barriers faced by residents. With current funding from the Health Resources and Services Administration, Workit Health is able to provide free treatment and medication for uninsured individuals in Ohio’s rural counties of Crawford, Ashland, and Hancock, where our work to expand access is currently focused. We also partner with pharmacies that can provide free, at-home medication delivery for individuals who face difficulty in accessing their medications.

SUD treatment in rural areas necessitates a comprehensive support network involving addiction treatment providers, healthcare networks, first responders, sheriff’s offices, and community-based organizations to effectively aid individuals. Embracing telehealth is essential, as it offers private and stigma-free care directly to individuals, effectively overcoming barriers related to geography and accessibility. Organizations must come together to champion telehealth as a vital option for patients in rural areas living with SUD, ensuring equitable access to treatment and support.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number HB1RH49881. This information or content and conclusions are those of the author and should not be construed as the position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

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