Recent research in Utah will help state policymakers better target resources to provide effective treatment to individuals with opioid use disorder (OUD), a particularly vulnerable population as the nation confronts a pandemic that has forced people to shelter in place for months. Evidence-based treatments are available, but physical distancing requirements have made getting access to those that require regular office visits increasingly difficult.
In addition, such distancing can exacerbate substance use, leading to relapse: Research shows that social isolation may increase the risk of prescription opioid misuse. In addition, early reports show that drug overdoses have already spiked in some areas as Americans have sheltered in place in response to the coronavirus pandemic.
Unfortunately, some states lack even basic information about how their program offerings align with residents’ needs. In order to make more informed decisions about how to improve treatment systems, policymakers need a baseline understanding of what programs are available and a sense of the barriers to providing and accessing treatment. The Results First initiative recently supported the Kem C. Gardner Policy Institute, a policy research organization based at the University of Utah, in conducting research to help fill these information gaps in Utah.
Utah has been hard-hit by the opioid epidemic, with drug overdose being the leading cause of injury death in the state. In April, the Gardner Institute released a report that provided lawmakers and other leaders with a comprehensive picture of evidence-based treatment programs in the state that combine counseling and medications approved by the U.S. Food and Drug Administration to treat OUD. The report offers a foundation for understanding the treatment landscape to help policymakers make better-informed decisions about how to narrow gaps in services.
To understand physical barriers to accessing treatment such as distance or travel time, Gardner created a catalog of all existing treatment programs in the state. Using this information, researchers built maps to show the locations of specific types of options and to provide insight into whether the supply meets existing demand, in part by examining local opioid death rates.
Using this data, policymakers can take steps to close treatment gaps. For instance, to increase access to care for rural populations, the state can explore research clearinghouses—including the Results First Clearinghouse Database—to identify evidence-based programs that are working elsewhere. State and local officials should review the options to choose those most likely to be effective in meeting their residents’ unique needs.
To supplement data on location and treatment type, researchers held a series of focus groups with a range of stakeholders—such as medical and behavioral health care providers, insurers, academics, and criminal justice system representatives—to better understand their perspectives on barriers to accessing and providing treatment and to gather ideas for improving the system. In addition to highlighting gaps in rural care, discussion group members cited a range of commonly identified issues that affect access to treatment, such as the stigma around OUD, gaps in the workforce needed to diagnose, treat, and support individuals with OUD, and high treatment costs. Participants also raised concerns about challenges such as attracting and maintaining medical prescribers and onerous Medicaid requirements.
Using baseline data from this research, Utah policymakers can identify how to expand evidence-based programs to fill treatment gaps and then begin to set goals and track their progress.
In the midst of tackling the many public health challenges that have arisen with the emergence of the coronavirus, states should maintain a focus on the needs of vulnerable populations, such as those facing opioid use disorder. Establishing a baseline to understand where treatment needs exist is the first step.
Sara Dube directs and Alyssa Doom is an associate manager for the Results First initiative.
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