Fewer than one in 10 people in rural areas who have opioid use disorder (OUD) and alcohol use disorder (AUD) are prescribed medications for both of their disorders, a study in the Journal of Substance Use and Addiction Treatment.
“The present study reinforces the gaps in treatment for patients with OUD and/or AUD who live in rural areas and calls for a better understanding of these gaps as well as additional support for rural clinicians in providing pharmacological treatment,” wrote Emily Kan, Ph.D., of the University of California, Los Angeles, and colleagues.
The researchers analyzed data from 1,874 adult patients who visited one of six rural primary care sites in the Northeastern and Northwestern United States at least once from October 2019 to January 2021. The patients all had a diagnosis code for OUD and/or AUD. The researchers also reviewed medications prescribed for OUD or AUD from the clinics' electronic health records. Medications were grouped into five categories: buprenorphine, oral naltrexone, injectable naltrexone, AUD medications like acamprosate or disulfiram, and combination treatment (buprenorphine plus acamprosate or disulfiram).
Overall, 54.2 % of the adults in the sample were diagnosed with OUD only, 37.9 % with AUD only, and 7.9 % with OUD and AUD.
The researchers found that 85.3% of patients with OUD and AUD were prescribed at least one type of medication, compared with 63.7% of patients with OUD and just 10.3% of patients with AUD. Furthermore, patients with both OUD and AUD spent an average of 264.7 days on medication, compared with 220.5 days for those with OUD and 62.5 days for those with AUD. However, only 8.8 % of patients with OUD and AUD were prescribed combination treatment or some form of naltrexone (which is approved for both disorders).
“The low rates of naltrexone prescription are concerning given current evidence of the effectiveness of extended release-naltrexone in treating both disorders,” Kan and colleagues wrote. They added that greater support for rural primary care clinics, such as integrating specialty expertise in OUD and AUD in assessing and treating these disorders and implementing telemedicine to remotely deliver treatment for OUD and AUD, could be practical next steps for addressing the low rates of pharmacological treatment of these disorders in rural communities.
For related information, see the Psychiatric News article “Medications, Open Communication Vital to Treating Substance Use Disorders.”
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