Rural drug-overdose rates, high in Kentucky, blamed partly on limits on treatment medication and mental-health services

“People in rural areas of Appalachia are more likely to die early deaths than in other parts of the country,” and a big reason is that they “die from drug overdoses at greater rates than the rest of the country,” writes Kery Murakami, the Washington, D.C., reporter for Community Newspaper Holdings Inc.’s CNHI News Service.

Murakami notes that in Leslie County, Kentucky, 7.9 of every 10,000 residents overdosed each year in 2012-14. “That’s six times the national rate,” and third in the nation, he writes, citing the annual County Health Rankings done for the Robert Wood Johnson Foundation by the University of Wisconsin Population Health Institute. Several other Appalachian counties in Kentucky and West Virginia rank high.

The rates are high partly because “addicts in some parts of the country get turned away by doctors and are not given a drug called buprenorphine that is used to kick opioid addictions,” Murakami reports, citing addiction experts. “Buprenorphine causes less euphoria and physical dependence and can ease withdrawal and cravings.”

However, “Federal law caps the number of patients to whom a doctor is allowed to prescribe the drug, out of concern of creating places where large numbers of addicts receive opioid-based medication. Such treatment hubs, much like methadone clinics, bring unwanted community opposition, said Mark Parrino, president of the American Association for the Treatment of Opioid Dependence.

That limits treatment choices in rural areas, where one doctor might be the only one licensed to prescribe buprenorphine for hundreds of miles.”

The Department of Health and Human Services is moving to ease the limits, and Sens. Ed Markey, D-Mass., and Rand Paul, R-Ky., want to go even further. “But some addiction experts are concerned that raising the caps on buprenorphine will nudge the country toward treating addiction with medication rather than counseling, Murakami reports. The department’s proposed rules would require mental-health care, which is often hard to get in rural areas. The senators’ bill would not.

“Turning people away from the most evidence-based treatment we have for a chronic, life-threatening disease is heart wrenching for a doctor,” Dr. Kelly Clark, president-elect of the American Society of Addiction Medicine, told CNHI. “Rural areas have been hit hardest by this round in overdoses, which is the worst round of overdose deaths in our country.” She said medication is especially important in rural areas because opioid use spreads among families.

“In rural areas, you’re treating the person, their parents and grandparents,” she said. “Entire families are addicted. It’s not like saying, ‘Stay away from certain friends,’ if they’re shooting up with their sister and their mother.”

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