Angi Edwards-Matheson, the assistant clinical director of the Southwest Behavioral Health Center in Utah, faces a major problem in fighting the opioid epidemic afflicting the state’s rural counties: Her treatment center struggles to attract medical professionals.
“It’s hard to recruit people, therapists included, to rural areas,” Edwards-Matheson said. “They don’t want to relocate there. It’s hard to build a practice with very, very small numbers of qualified prescribers, and have it be a successful practice.”
The Southwest Behavioral Health Center’s funding problems are symptoms of a larger problem with the government’s efforts to contain the opioid crisis. Federal funding is allocated mostly to large urban areas rather than small communities such as those in southern Utah. Despite passing sweeping opioid legislation in 2016, Congress has struggled to direct aid to rural counties.
The rate of prescription opioid and heroin-related deaths declined in 2017 by almost 20%. While the decrease in deaths is encouraging, health professionals like Edwards-Matheson are still worried about a lack of resources in the regions her practice serves. She hopes that more funding from the federal government will reach the local and community levels.
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A particular problem for rural Utah counties is that they lack authorized healthcare providers to administer buprenorphine, a medication for opioid use disorders that can only be prescribed by a healthcare professional. Many of those who become qualified to prescribe buprenorphine, Edwards-Matheson says, gravitate toward urban centers.
Buprenorphine was a breakthrough when it was introduced in 2002. It allows patients to receive treatment in an office setting and take a daily medication at home or at the pharmacy rather than go to a methadone clinic daily. It can help save lives, but not every county in Utah has treatment centers to provide buprenorphine.
Congress passed the Comprehensive Addiction and Recovery Act of 2016 in part to provide small and rural towns the same access to treatment drugs as bigger communities such as Salt Lake City, but three years later, the effort hasn’t panned out.
One provision of the law meant to help rural areas authorize nurse practitioners and physician assistants to prescribe buprenorphine for five years. With a Drug Enforcement Administration-approved waiver and at least 24 hours of training, nurse practitioners and physician assistants would be authorized to save lives of addicts in the most remote areas.
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As Edwards-Matheson is quick to point out, the remaining problem is luring these professionals away from big cities. There are few financial incentives for healthcare providers to move to more remote areas.
“These counties are aware that to have the amount of resources that you have in an urban area is extremely expensive,” Edwards-Matheson said.
Sen. Rob Portman, R-Ohio, introduced an updated bill for addiction recovery in May 2018. It would add funding for recovery resources in rural and underserved areas. “We have the opportunity to build on this effort, increasing funding levels for programs we know work and implementing additional policy reforms that will make a real difference in combating this epidemic,” he said in a statement.
The bill, dubbed “CARA 2.0,” authorizes a total of $1 billion in resources to prevention, research, education, and enforcement. Much of the funding will go toward first responder training and expanding the study of medication-assisted treatments.
It also includes a provision that President Trump signed into law as part of separate opioids legislation in November 2018, allowing nurse practitioners and physician assistants to prescribe medication-assisted treatment, including buprenorphine, for an unlimited amount of time, rather than for just five years.
Buprenorphine is still a Schedule III drug and can only be dispensed by a healthcare professional. It does not pose the same risks as heroin, which is very fast-acting, but could cause some psychological dependence. Because buprenorphine has a long half-life, meaning it stays in a person’s system for at least 30 hours, the chances someone of abusing it is minimal.
