The National Rural Health Association (NRHA) submitted to the United States Senate Committee on the Judiciary a statement for the record on Attacking America’s Epidemic of Heroin and Prescription Drug Abuse:
Testimony of the National Rural Health Association (NRHA)
Attacking America’s Epidemic of Heroin and Prescription Drug Abuse
Submitted for the Record to the United States Senate Committee on the Judiciary
The National Rural Health Association (NRHA) is pleased to provide the United States Senate Committee on the Judiciary with a statement for the record on Attacking America’s Epidemic of Heroin and Prescription Drug Abuse. We applaud your efforts in combating this epidemic that is crippling rural communities across the country.
NRHA is a national nonprofit membership organization with a diverse constituency of 21,000 individuals and organizations who share a common interest in rural health. NRHA’s mission is to improve the health of rural Americans and provide leadership on rural health issues through advocacy, communications, education, and research
While only 20 percent of Americans live in rural areas, a disproportionate number of rural communities are struggling with prescription opioids and heroin abuse. According to the Centers for Disease Control and Prevention, rural Americans are more vulnerable to prescription painkiller abuse and overdoses, and the rate of opioid-related overdose deaths in nonmetro counties is 45 percent higher than in metro counties.
While opioid use generally is on the rise, rural adolescents and young adults are particularly vulnerable. Researchers have identified “a striking shift in the prevalence of fatal drug overdoses from urban to rural counties.” The ongoing social and economic challenges that fuel substance abuse are rampant in rural America, including high unemployment and a prevalence of injuries that result in opioid prescriptions, have led to rural America being hardest hit by the opioid epidemic.
The opioid crisis impacts rural communities in multiple ways – from the direct cost to individuals suffering from opioid addiction including ongoing health problems, high rates of overdose deaths, and greater risk of homelessness, exposure to HIV and hepatitis-C, and incarceration. Dramatic increases in rates of HIV and Hepatitis C in rural Scott County, Indiana have been traced directly to the intravenous injection of Opana is only one example.
Furthermore, rural communities are seeing increased criminal behavior to support drug habits, including increased theft and property crime as well as sex trafficking and proposition. Domestic violence and child abuse and neglect are also on the rise because of the increased rates of criminal activity resulting from drug abuse higher rates of domestic violence, child abuse and neglect. This creates a greater demand on health care, social services and criminal justice systems, without a sufficient increase in resources to handle the increased workload.
Rural Americans in need of substance abuse treatment services and behavioral health care will find that access to care can be limited. Even with rural telemedicine services improving access to mental health care, 60 percent of rural Americans live in a mental health professional shortage area. Unfortunately, the problem of access to care is not limited to substance abuse. A growing number of rural Americans do not have local access to comprehensive care and face a number of challenges when trying to access health care. Seventy-seven percent of rural counties in the U.S. are Primary Care Health Professional Shortage Areas while nine percent have no physicians at all. Primary care providers are the best opportunity to connect individuals to mental health care resources prior to a crisis when the criminal justice system or emergency medical providers are responding.
Rural Americans are forced to travel significant distances for care, especially specialty services such as mental health services. In an emergency, rural American travel twice as far as their urban counterparts to receive care. Unfortunately access continues to degrade in rural America as seventy-eight rural hospitals have closed since 2010, leaving millions more rural Americans without timely local access to care. This means rural Americans are farther away from emergency care, as well as options for the ongoing treatment that is essential for successfully treating substance abuse. Access to care is practically lacking for mental health and substance abuse, and sadly, the need for this type of care to be accessibly and local is essential. In 55 percent of all American counties, most of which are rural, there are no psychologists, psychiatrists or social workers.
Because of the disproportionate number of rural Americans affected by this epidemic, there is a greater need to expand access to local substance abuse treatments. Additionally, the differences between rural and urban settings, culture, and resource availability means the solution for rural America must be uniquely tailored to rural. NRHA believes that improving access to care must be a priority for both the Administration and Congress, and submits the following recommendations:
1. Expand access to substance abuse treatment services including medication assisted treatment and traditional psychosocial substance abuse treatment programs. Treatment programs must be available locally and tailored to the unique needs and characteristics of rural Americans. Treatment programs must be able to leverage the health care providers in the community while using telehealth and other resources to bring new providers into the community. This would include recovery and peer support services.
2. Support the implementation of models to engage rural communities in addressing opioid issues. Broad community coalitions, including schools, law enforcement, and medical providers, need to be a part of the rural solution.. These community coalitions must focus not only on treatment, but also on prevention and harm reduction.
3. Develop and Identify evidence-based prevention programs tailored to the needs of rural communities.
4. Increase the implementation of harm reduction strategies. Harm reduction is an essential part of dealing with the existing problem and will require training of law enforcement and first responders, as well as the use of interventions known to reduce the harm of drug use including needle exchange and naloxone.
5. Promote use of evidence-based prescribing guidelines. Pain management is an important component of health care. However, measurement of hospital and physician quality must balance the need to address patient’s legitimate pain with the need to avoid misuse and diversion of pain medications. We need to ensure that doctors have the guidance about the appropriate use of these medications, while also not penalizing providers for following appropriate prescribing criteria.
6. Strengthen state prescription drug monitoring programs (PDMPs).
7. Expand use of substance abuse treatment as an alternative to incarceration for opioid users. Those facing substance abuse or mental health crisis may wait years before seeking treatment from a professional, particularly in rural America where the stigma discourages people from seeking treatment and views addiction as moral failure. As a result, interaction with the legal system is the first meaningful opportunity for rural Americans suffering from addiction to actually receive treatment.
The National Rural Health Association appreciates the opportunity to provide our recommendations to the United States Senate Committee on the Judiciary. These programs are critical to the rural health delivery system and to maintain access to high quality care in rural communities. We greatly appreciate the support of the Committee and look forward to working with Members of the Committee to continue making these important investments in the health of our rural Americans.