0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Viewpoint |

Access to Treatment for Opioid Dependence in Rural America Challenges and Future Directions

Stacey C. Sigmon, PhD1
[+] Author Affiliations
1Department of Psychiatry, University of Vermont College of Medicine, Burlington
JAMA Psychiatry. 2014;71(4):359-360. doi:10.1001/jamapsychiatry.2013.4450.
Text Size: A A A
Published online

Extract

Opioid abuse is reaching epidemic proportions in the United States. The consequences of opioid abuse and dependence include emergency department visits, premature death, HIV, hepatitis, criminal activity, lost workdays, and economic costs that in the United States exceed $56 billion annually.1 Agonist maintenance is the most efficacious treatment for opioid dependence and dramatically reduces morbidity, mortality, and spread of infectious disease. However, demand for opioid maintenance treatment far exceeds available capacity. Due to inadequate public funding, unfavorable zoning regulations, and requirements for comprehensive care in programs that increase their cost, an alarming number of methadone clinics have extensive waitlists.2 Further, while approval of buprenorphine in 2002 extended agonist maintenance into general medical practices, many areas of the country have an insufficient number of physicians willing to prescribe buprenorphine, in part due to concerns about induction logistics, reimbursement challenges, potential for medication diversion, lack of professional support for the clinicians, and lack of psychosocial services for patients.3 One result of the current situation is that opioid-dependent patients can remain on waitlists for years, during which they are at substantial risk for illicit drug use, criminal activity, infectious disease, overdose, and mortality.4

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

1,088 Views
14 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
JAMAevidence.com

Care at the Close of Life: Evidence and Experience
Homeless Patients in the Health Care System

Care at the Close of Life: Evidence and Experience
Providing Palliative Care Amid Social Disorganization

brightcove.createExperiences();