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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.
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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

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