Report: Rural areas have less access to substance use treatment resources

By Cassie Miller – Capital-Star

HARRISBURG, PA – Individuals with substance use disorder living in rural areas of the country have significantly less access to treatment options, putting more strain on rural hospitals, a new study found.

The study, conducted by the East Tennessee State University/NORC Rural Health Equity Research Center, found that individuals with substance use disorder living in rural areas had limited access to health care providers, treatment programs, and specialty resources compared to those living in urban areas.

“While all areas of the country face a SUD epidemic, rural areas have been hit hardest and currently have limited resources to address the crisis,” Craig Holden, senior research scientist with the NORC Walsh Center for Rural Health Analysis, said.

The study noted that limited access to SUD prevention and treatment services can also affect local hospitals, by increasing inpatient hospital utilization.

The national rate of opioid-related inpatient hospital stays nearly doubled in the decade between 2007 to 2017 to a rate of 300 people per 100,000 population.

The study also examined admission characteristics based on available data and found that the percentage of inpatients with a primary SUD diagnosis admitted through court or law enforcement channels was four-and-a-half-times higher for rural residents (5.8%) than for urban residents (1.3%).

Medicaid was the largest primary payer of SUD-related inpatient stay claims for rural (44%) and urban patients (40%). However, the study found that patients from urban areas “more often had private insurance listed as the primary payer than rural resident patients.”

Rural regions of Pennsylvania have been deeply affected by the opioid epidemic and substance use disorder, with approximately 299,000 Pennsylvanians experiencing drug use disorder, according to 2020 state data.

Several rural counties report more than 620 individuals with drug use disorder over the same timeframe, including Tioga County, Pike, Wayne, Columbia, Northumberland, Jefferson, Clearfield, Adams, Bedford, and Somerset counties.

“All Pennsylvanians living with substance use disorder deserve access to high-quality treatment no matter where they live,” Department of Drug and Alcohol Programs Spokesperson Stephany Dugan, said.

The study found that patients from rural areas were younger, more often white females, “and had a primary SUD diagnosis more likely related to opioids, stimulants or other/miscellaneous substances as compared to urban patients.”

Patients from urban areas, by contrast, were more often diagnosed with alcohol-related SUD and had five or more comorbidities as compared to inpatients from rural areas, according to the study.

Dugan told the Capital-Star that DDAP, which oversees the state’s efforts to reduce substance misuse and dependency, is “working to expand access to treatment while ensuring high-quality, equitable resources so more Pennsylvanians can live long and healthy lives free from the disease of addiction.”

During former Gov. Tom Wolf’s administration, the agency held roundtables with stakeholders and community members in several counties across the commonwealth — including rural ones — hoping to learn what strategies they are employing at the local level to help people access care, and to hear where they could use more support and resources.

Democratic Gov. Josh Shapiro has proposed allocating $48.1 million to the department’s efforts in his 2023-24 fiscal year budget.

Based on the study’s findings, researchers concluded that more data is needed to identify national ways “to improve and streamline access to SUD care for rural residents.”

“This study further highlights the importance of attention to those who live in rural areas and the urgency to bring equitable health resources to them,” Robert Pack, director of the ETSU/NORC Rural Health Equity Research Center, said in a statement.