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Treating the Opioid Crisis in Rural America

By now, we know the numbers about how the opioid crisis is devastating our nation and especially destroying our rural communities. While only 20 percent of Americans live in rural areas, a disproportionate number of rural communities are struggling with prescription opioids and illicit drug abuse. According to the Centers for Disease Control and Prevention, rural Americans are more vulnerable to prescription painkiller abuse and overdoses, and the rate of opioid-related overdose deaths in nonmetro counties is 45 percent higher than in metro counties.

A striking shift exists in the prevalence of fatal drug overdoses from urban to rural counties due to high unemployment and a greater rate of the types of injuries that result in prescriptions for opioid medications. The opioid crisis is creating greater demands on health care services in rural America that are already spread incredibly thin. Eighty-three rural hospitals have closed since 2010, leaving millions of rural Americans without timely local access to care. Rural Americans are farther away from emergency care and treatment options, especially for mental health and substance abuse. In 55% of all American counties, most of which are rural, there are no psychologists, psychiatrists or social workers.

Even our next generation of rural Americans is being harmed by this crisis. A recent University of Michigan study found rates of babies born with opioid withdrawal symptoms rising much faster in rural areas, and according to the CDC, teen use of opioids is higher in rural communities. According to the National Institutes of Health, in the United States, a baby is born suffering from opioid withdrawal every 25 minutes.

We know that there are solutions:
  • Protect Medicaid as a funding source to provide treatment.
  • Expand access to substance abuse treatment services including medication assisted treatment and traditional substance abuse treatment.
  • Develop evidence-based prevention programs tailored to the needs of rural communities.
  • Increase the implementation of harm reduction strategies.
  • Promote use of evidence-based prescribing guidelines and strengthen prescription drug-monitoring programs.
  • Expand use of substance abuse treatment as an alternative to incarceration.

And legislation has already been introduced that will move us in the right direction:
  • The Federal Opioid Response Fairness Act of 2018, H.R. 5109, Kuster (D-NH-2), Jenkins (R-WV-3), McKinley (R-WV-1), Blunt Rochester (D-DE-At Large), Poliquin (R-ME-2), Courtney (D-CT-2); Targeted Opioid Formula Act, S. 2125 – Shaheen (D-NH), Hassan (D-NH), Capito (R-WV), Manchin (D-WV): Changes the formula used for allocating opioid funding so that states most in need receive funding by reducing emphasis on population in the formula.
  • The Addiction Recovery for Rural Communities Act, H.R. 3566 – Bustos (D-IL-2), Crawford (R-AR-1), Marshall (R-KS-1), Evans (D-PA-2), Kuster (D-NH-2); (S.2137) – Donnelly (D-IN), Roberts (R-KS): Sets aside 20% of the USDA’s Distance Learning and Telemedicine Program grant funding for substance abuse treatment; prioritizes USDA Rural Health and Safety Education grant funding for applicants seeking to improve education and outreach on substance abuse issues.
  • CRIB Act, H.R. 2501 – Jenkins (R-WV-3), Turner (R-OH-10), Ryan (D-OH-13), Clark (D-MA-5); S.1148 – Brown (D-OH), Capito (R-WV), King (I-ME), Portman (R-OH): Allow a state Medicaid program to cover inpatient or outpatient services at a residential pediatric recovery center for infants with neonatal abstinence syndrome (a postnatal drug withdrawal syndrome) and their families.
  • Top OD Act, H.R. 664 – Joyce (R-OH-14), Ryan (D-OH-13): Expands grants for education and naloxone training and administration.
  • Preventing Overdoses While in Emergency Rooms Act (POWER) of 2018, H.R. 5176 – McKinley (R-WV-1), Doyle (D-PA-14): Provides grants to establish policies and procedures for administering MAT and develop best practices for care coordination.
  • Tribal Addiction and Recovery Act of 2018 (TARA), H.R. 5140Mullin (R-OK-2), Cole (R-OK-4), Gianforte (R-MT-At Large): Makes Indian tribes eligible to be direct grantees of State Targeted Response to the Opioid Crisis Grants; Tribes would receive their own $25 million allocation that they could apply directly to the federal government to receive, instead of working through state governments.

Today and tomorrow, the Energy and Commerce Committee will begin to consider 25 pieces of legislation, including TARA and the POWER Act as part of an endeavor to pass a package of opioid legislation. We appreciate the efforts of these Members of Congress, and we ask that they ensure that all of the above legislation be included in any final opioid package.

This crisis has destroyed so many rural communities, and as we make progress to combat the epidemic of prescription and illicit opioids in our country, we cannot afford to leave rural America behind.

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