When it comes to addiction in rural areas, we need to look at everything that works

While the opioid crisis has affected most areas of the United States, rural areas have been largely unprepared to deal with the misuse, addiction, and overdoses that have drastically increased over the last two decades. Increases in prescription opioid dispensing in rural areas have contributed to rates of opioid misuse and addiction that had not previously been seen. In 2019, Kentucky had the seventh-highest drug overdose death rate in the country and things have only gotten worse since the onset of the pandemic. Between 2020 and 2021, Kentucky saw the third-highest increase in drug overdose rates in the nation, with a 50% year-over-year increase. Most of these drug overdose deaths involved fentanyl.

Evidence-based treatments for addictions, the ones that we have evidence to show that they work, tend to be less available in rural areas. Drug-related overdose deaths have risen steadily in rural areas, yet rural residents are less likely to be administered naloxone (i.e. Narcan) during an overdose than those in urban areas. Similarly, while access to medications for opioid use disorder like buprenorphine has improved over the last decade, rural areas have seen smaller increases in availability to treatment than more urban areas. One reason for this may be that stigma tends to be worse in rural areas where people are more supportive of abstinence-based treatment options over harm reduction strategies.

Harm reduction is a philosophy of decreasing the risk of harm from substance use. Of course, abstinence does reduce harm, but harm reduction includes alternatives to abstinence that reduce harm by making drug use safer. Medications for Opioid Use Disorder (e.g. buprenorphine, methadone, and naltrexone), safe injection supplies, overdose response kits, and fentanyl test strips are important ways to reduce the harms associated with opioid misuse, however these harm reduction strategies are often lacking in rural areas. Moral beliefs about what “true recovery” consists of and stigma related to substance use affect access to and utilization of these strategies among rural residents.

Access to addiction treatment is also limited by unique challenges associated with living in rural areas. Rural residents are more likely to have to travel long distances, sometimes across county and state lines, to access treatment. This is a significant barrier to participating in treatment, especially without public transportation available and with the increasing costs of both gasoline and vehicles. Limited childcare availability and funding is another barrier to seeking treatment for caregivers.

Agencies like FAHE are making strides to improve access to treatments for addictions by funding programs to address these barriers. The Kentucky Access to Recovery program has reduced these barriers by providing individuals recovering from opioid use disorder or stimulant use disorder with financial assistance to obtain resources like housing, transportation, childcare, and dental care from local small businesses. In addition to providing needed resources that make it more feasible to participate in recovery services, Kentucky Access to Recovery fosters interactions and relationships between people who use drugs and community members, helping to reduce stigma in the community. More funding for programs like Kentucky Access to Recovery and mobile distribution of harm reduction strategies in rural areas is needed. Education efforts are also needed for community members as well as the providers and clinicians working in rural areas to increase the utilization of harm reduction strategies. The opioid crisis is still with us, and in fact, it is worsening. We know how to curb the harms associated with opioid addictions. We must put aside our insistence on abstinence and be open to harm reduction strategies that save lives.

Aaron Brown is a Licensed Clinical Social Worker and addictions researcher who is joining the social work faculty at the University of Kentucky this fall.