In the first post of this series, we began looking at the problems with the existing system in place to treat the wide-spread issue of opiate addiction. Today we ask, with millions of Americans already addicted to opiates and trying to navigate the many barriers they encounter as they try to access the appropriate care, what exactly is at risk for those who fall through the cracks?
During any disruption or deviation from recommended care, OUD patients are at high risk of experiencing chronic symptoms, acute withdrawal, underlying behavioral health or pain management concerns, and relapse. They are already juggling social stigma and often self-stigma, travel and transportation needs, balancing work and child care and other demands of life just to get to the doctor’s or therapist’s office. Quite frankly, we are leaving these vulnerable patients, many of whom were given legitimate prescriptions for the opioids that led to their addiction in the first place, to figure out recovery on their own or suffer the consequences.
And in many respects, the problem is much worse in rural communities. A 2018 study by the American Journal of Preventive Medicine found that 65% of the nation’s non-metropolitan communities lack a psychiatrist. Just 47% of non-metro communities have psychologists, and many certified addiction counselors have trouble accepting OUD patients alongside their non-addiction clients in their offices. A Health Resources and Services Administration study found that the patient-to-primary care physician ratio in rural areas is approximately 39 physicians for every 100,000 people. Many patients aren’t aware that qualified addiction specialists and DATA-2000 waivered MAT providers are available within their communities to treat their withdrawal symptoms, believing that the only way to get care is to go to an intensive hospital or residential clinic program.
And with so few providers available in these rural areas where so many Americans live, the battle with stigma is even greater. Fear of running into other patients and being “outed” as an addict may be strong enough to repel someone from the waiting rooms in doctor’s and therapist’s offices, and even from pharmacies to fill prescriptions for medications like Suboxone and Naloxone. A patient who misses too many appointments or who experiences a relapse may be closed out of treatment, with few or no alternatives, and shame may make it too hard to try to re-apply for services again.
With relapse rates as high as 60%, and the risk of death from overdose high during a relapse, the dangers that can result from a disruption of treatment are all too real. Stay tuned for our final post in this series, Part 3: The Future of Addiction Treatment, where we will examine some of the proposed solutions to address the problems related to successful treatment, and what PursueCare is attempting to do to help.