August 2008 Newletter
August 1, 2008
Matthew Gever
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In This Issue...
Opioid Treatment Lacking in Rural Areas
Rural residents have a harder time accessing substance abuse treatment than their urban counterparts, and the problem is even more pronounced among opioid treatment programs (OTP), according to a new study and accompanying issue brief from the Maine Rural Health Research Center. Just under 9 percent of all substance abuse facilities in the country are found in rural communities. Based on overall population, rural areas have a slightly higher proportion of actual facilities but far fewer patient beds compared to their urban counterparts (see chart below).The disparities increase for OTPs, methadone clinics in particular. For example, only 1.9 percent of all OTPs are located in a rural county that is not adjacent to an urban county. Travel to urban areas is often long and difficult for rural residents, especially on a daily basis as would be required by a methadone treatment program. Other barriers cited include stigma associated with OTPs and difficulties in recruiting specialists out to rural areas.
Urban areas also head a greater proportion of facilities in which substance abuse was the sole focus, whereas rural areas had more facilities that combined substance abuse and mental health services. The report attributes this to difficulties in recruiting and retaining specialists in rural areas thereby forcing more providers to offer a broader range of services. More urban facilities also offered specialized services such as detoxification—a role more often taken up by jails in rural areas. On the other hand, rural facilities were more likely to provide transitional housing, which the authors hypothesize is due to stricter zoning laws in urban areas.
Source: Jennifer D. Lenardson and John A. Gale, Distribution of Substance Abuse Treatment Facilities Across the Rural – Urban Continuum, Maine Rural Health Research Center, February 2008. Accessed at http://muskie.usm.maine.edu/Publications/rural/pb35bSubstAbuseTreatmentFacilities.pdf
Fewer Completing Opioid Treatment
The Substance Abuse and Mental Health Services Administration (SAMHSA) just released its most recent Treatment Episode Data Set, which provides information on patients undergoing addiction treatment. The report measures treatment completion, length of stay in treatment, and demographic and substance abuse characteristics for patients discharged from drug and alcohol treatment facilities. Overall, treatment completion rates were highest for those in hospital residential treatment, detoxification and short term residential treatment. Patients undergoing opioid replacement therapy had the lowest rates of completion, with only 11 percent of patients finishing treatment and 45 percent of patients dropping out. The report did not present any hypotheses as to why the completion rate was so low. Read more here: http://wwwdasis.samhsa.gov/teds05/TEDSD2k5TOC.htm
Reason for discharge from outpatient opioid replacement therapy: TEDS 2005
Source: Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Treatment Episode Data Set (TEDS): 2005. Discharges from Substance Abuse Treatment Services, DASIS Series: S-41, DHHS Publication No. (SMA) 08-4314, Rockville, MD, 2008.
The Costs of Under-Treating Addiction
The Johns Hopkins University Hospital spent close to $50 million in 2002 to treat people who abused one or more drugs, according to a new study in the Journal of Substance Abuse Treatment. The study followed admissions from 1994-2002 for patients with co-occurring alcohol and drug addiction. Four usage patterns were reported: 49% used a combination of two or more drugs, 25% used alcohol only, 11.8% used opioids only, and 6.5% used cocaine only. Patients on Medicaid or Medicare represented 70 percent of these admissions. The cost of treating those abusing two or more drugs rose 119 percent over the course of the study while treating those using only opioids rose 482 percent over the eight-year period. The study also noted that both public and private insurers spend very little on addiction treatment, which accounts for less than 1 percent of private claims and 2 percent of Medicaid claims.
More Methadone Clinics Opening in Suburbia
An increasing number of methadone clinics are opening in the nation's suburbs and breaking down the stereotypical image of the methadone patient, reports The Vindicator. Most of these clinics are private and for-profit and accept most medical insurance. Community resistance is common. However, clinics try to dispel any fears by serving patients quickly. The paper expects more of these clinics to open, especially in its home region of Western Pennsylvania, due to trends of increasing heroin use in the eastern United States.
Study Examines Prescription Pain Reliever Abuse at Local Level
Non-medical use of prescription pain pills has become the nation's second most prevalent drug problem, according to a new report from the Substance Abuse and Mental Health Services Administration (SAMHSA). For example, since 2002, the number of people using pain medications non-medically for the first time has outpaced the number of first-time marijuana users. Looking at the topic in more detail, the report examines the rates of prescription abuse at the sub-state level, monitoring usage patterns in various areas of each state. regions with the highest rates of abuse were most common in Southern and Western states, while those with lowest rates were found in the North.
Nonmedical Use of Pain Relievers in the Past Year among Persons Aged 12 or Older, by Substate Region
Source: Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (June 19, 2008). The NSDUH Report: Nonmedical Use of Pain Relievers in Substate Regions: 2004 to 2006. Rockville, MD.
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