A new report from the University of Vermont highlights how challenges faced by providers and their patients are hindering access to drug treatment for opioid use disorder in rural Maine.
UVM’s Center on Rural Addiction worked with the Cutler Institute at the University of Southern Maine to survey more than 300 practitioners and community workers in all 16 counties of Maine between April and June of last year. All respondents worked in at least one federally designated rural area.
The assessment of universities, published in May this year, shows how, in particular, staffing and time constraints, barriers to access for patients – transport, paid leave, childcare, for example – and increasingly lethal drugs taken in combination with other substances, are major concerns for this group when it comes to providing care to rural patients.
“Transportation is a huge problem. We don’t have reliable transportation,” said a practitioner who is currently treating with medication for an opioid use disorder.
Long journeys to the nearest clinic, lack of childcare or insurance, and lack of providers and other community supports are also unique barriers for rural patients, several other practitioners said. .
When it comes to providing drug treatment, nearly half of practitioners said that staffing constraints and concerns about diversion – that drugs would end up in the hands of someone other than the patient – were their main barriers to providing treatment.
An overwhelming majority of practitioners and more than half of community responders said transportation prevented patients from receiving and continuing their treatment.
The majority of practitioners also cited lack of social support, lack of stable housing, and lack of paid leave or childcare as contributing factors.
Some community responders – about a third of whom each work in first responders, schools and other settings, such as recovery centers or community health organizations – also said that the lack of social support and coordination of care, insufficient capacity to treat patients, and difficulties in getting patients to comply with treatment demands, were barriers.
When asked what the biggest improvement is needed, one community responder said Maine needs to “put some boots on the ground and do some outreach in the areas we know are hardest hit.”
Another said Maine needs more facilities, especially in northern Maine.
“Waiting lists are long and we lose many people in the short time after they decide to go into recovery,” one said.
All respondents, but especially practitioners and people who worked in other community settings, said that stigma is one of their main concerns as to why people do not seek or stay in treatment for a disorder. related to the use of opioids.
One practitioner said providers need to know more about how their attitudes towards patients, particularly their shame, can affect outcomes.
“Shame should never be used to change a patient’s unhealthy behaviors. However, I see it too often in clinical practice,” the practitioner said. “Many patients feel tremendous shame around their UUD. As health care providers, we should not accumulate more shame on top of patient shame. Instead, we should create cultures of practice open, honest, transparent and non-judgmental and learn how to prepare for difficult and vulnerable conversations with our patients with TOU.
When it comes to substances of most concern, practitioners on average named opioids in combination with benzodiazepines, opioids in combination with alcohol, and fentanyl as their top three, respectively.
On average, community responders named fentanyl, heroin and prescription opioids as their biggest concerns.
These are well-placed concerns, according to the latest Monthly Overdose Report from the University of Maine and the Attorney General’s Office.
The latest report, released late last month, shows that non-pharmaceutical fentanyl, a type of synthetic opioid, continues to be the most common cause of fatal overdoses.
From January to March, there were 230 confirmed drug overdose deaths. Non-pharmaceutical fentanyl was present in three quarters of them.
Continuation of trends from 2021, while deaths from heroin, alone or in combination with other drugs, are declining, deaths from stimulants are increasing.
While in 2020 heroin was present in 11% of fatal overdoses, the opioid was found in 4% of deaths last year and just 2% of deaths up to May this year.
In contrast, the percentage of fatal overdoses involving the stimulants methamphetamine and cocaine recorded in the first five months of this year was higher than it was last year and in 2020.
And for the first time last year, xylazine and non-pharmaceutical tramadol were identified as co-intoxicants with fentanyl. Xylazine, a veterinary tranquilizer, and tramadol, an opioid painkiller, are increasingly appearing mixed with fentanyl in pills and powders, according to the report.
The three drugs are sedatives and slow breathing. When combined, they can be extremely deadly.
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