Growing Consensus on Rural Opioids

HRSA Administrator Dr. George Sigounas pledged the agency's continued support on Tuesday, June 18, for rural communities racked by the opioid crisis, observing that 600 regions across 40 states now have consortiums in place to get those suffering into care.
HRSA Administrator Dr. George Sigounas pledged the agency's continued support on Tuesday, June 18, for rural communities racked by the opioid crisis, observing that 600 regions across 40 states now have consortiums in place to get those suffering into care.

 

"While one in five rural residents receive care at a HRSA-funded health center, I don’t have to remind you that rural residents face specific challenges when trying to access care for substance use disorder."

- Dr. George Sigounas, noting that HRSA alone has invested more than a quarter-billion dollars in opioid funding since 2018.

 

Speaking  at the Rockville Hilton before one of the largest gatherings of its kind, Dr. George Sigounas outlined Tuesday a five point HRSA plan for "bridging the treatment gap" and blunting the opioid crisis in rural America.  He told some 400 grantees, advocates and clinicians that they hold the key to finding "solutions (that) serve the American people, particularly those afflicted with substance abuse and behavioral health needs."

Funding for HRSA's four rural opioid response programs over just the past two years, he added, represent "the largest budget increase the Federal Office of Rural Health Policy has ever seen," one also marked by new opioid outlays for HRSA-funded health centers, Ryan White clinics and National Health Service Corps placements to affected communities.

 

About 400 rural opioid activists and grantees gathered in Rockville, Maryland on June 18
HRSA Administrator Dr. George Sigounas and agency rural chief Tom Morris welcomed some 400 rural opioid activists and grantees at the Rockville Hilton on Tuesday, June 18 to discuss lessons learned, pending grant opportunities and the urgent need to train more first responders, clinicians and civilians alike to use naloxone to cut the death rate in distant communities.

 

Those funds, grantees reported, have helped fuel the rapid start-up and expansion of sophisticated "care networks" of first responders, health centers, hospitals, universities, telehealth hubs and rehab facilities that previously did not exist in many parts of the country. With those networks has come increasing data on the scope and dimension of the crisis in small towns and distant outposts of America:

  • In Michigan's Upper Peninsula, for example, there is one residential treatment program for women in an area spanning 300 square miles. And many who seek care have high-deductible insurance plans, difficulty finding child care for an extended stay, or are pregnant. "That is a huge barrier for us," said grantee Gail Ploh of the Michigan Rural EMS Network;
  • In many counties, grantees said, local sheriffs and judges have continued to rely on enforcement and incarceration as a response to the crisis. "Judges are still taking children, even though the mom is in the regimen" to recovery," said one grantee. "It's painful, but that's what we're hearing." Any effective community strategy, said Betty-Ann Bryce of the Office of National Drug Control Policy, "has to have local law enforcement at the table";
  • Said Ruston Seaman, a grantee and church pastor from Philippi, W. Va.: "Four out of 10 children in our area don't have parents because of opioids. And that's a challenge for us every day."   

Bryce, who spent 2018 holding opioid "roundtables" across the country for the USDA -- April, Utah: May, Kentucky; June, Oklahoma; by July 11 of last summer, she was in Maine -- said she initially planned five such regional sessions with local mayors, sheriffs and hospital executives.

But as word got around, she was forced to schedule 10, then 15, then 20  more sessions ... soon enough, she was briefing managers at Walmart and Starbucks concerned about workforce absenteeism due to court appearances, incarcerations and a lack of treatment facilities.

"I had police chiefs calling me up, asking: "Why wasn't I invited?" and 'When's your next session?'" she recalled.

 

Pastor Ruston Seaman of  Philippi, W. Va. (left) said families and communities are being strained to the breaking point by opioid deaths;  Betty-Ann Bryce (right) toured the country for the USDA, witnessing the rural opioid crisis first hand; FORHP Associate Administrator Tom Morris echoed her conclusion that broad local coalitions of officials in health care, law enforcement, transportation, religious congregations and employers must act together to confront the stigma of addiction and build new care systems where they may not have previously existed.  "If you find yourself talking about someone who is not at the table," said Bryce, "stop talking, and go out and get them to the table."
Pastor Ruston Seaman of  Philippi, W. Va. (left) said families and communities are being strained to the breaking point by opioid deaths;  Betty-Ann Bryce (right) toured the country for the USDA, witnessing the rural opioid crisis first hand; FORHP Associate Administrator Tom Morris echoed her conclusion that broad local coalitions of officials in health care, law enforcement, transportation, religious congregations and employers must act together to confront the stigma of addiction and build new care systems where they may not have previously existed.  "If you find yourself talking about someone who is not at the table," said Bryce, "stop talking, and go out and get them to the table."

 

"Communities are built on people who are directly affected (by opioids) and people who are indirectly affected," she added. "If people don't see it in their families, or see it in their jobs, they (say), 'This is not my problem.' But we see it in the lack of economic investment, in the loss of your ability to attract business to your community ... this is the conversation that brings the other partners to the table."

Over half of rural counties nationwide lack a provider who is authorized to prescribe opioid replacement drugs like buprenorphine -- and rural opioid users tend to be more likely to be uninsured, less educated, and to have lower income than their urban counterparts, FORHP has reported.

Grantees also cited as a hindrance the lack of transportation infrastructure in distant communities. As in the HIV/AIDs epidemic of the past, time and distance to care is a continuing obstacle -- which FORHP is seeking to solve through remote telehealth hubs and the funding of local faith-based groups that can bring care and counseling to isolated communities, on foot if necessary.

"Our real hope is that through these investments ... we'll probably be able to start building a treatment infrastructure in rural communities that heretofore has not existed," said HRSA's Tom Morris. "And that's the challenge for us, but also a unique opportunity. The real work starts with what you all are doing on the ground."

Read more about the conference.

Date Last Reviewed:  June 2019