We are in the midst of a stunning public health crisis. Since 2000, opioid use has caused half a million deaths in the United States, including 64,000 last year alone. President Donald Trump declared a public health emergency in 2017, and Congress is expected to introduce a number of bills in the coming months in an attempt to impact the issue of prescription opioid abuse.
Pennsylvania has suffered greatly during the growing opioid epidemic. Opioid overdoses now account for more deaths statewide than car crashes. This led Gov. Tom Wolf to declare the heroin and opioid epidemic a statewide emergency at the start of 2018.
Gov. Wolf acted in order to help improve the state response to this tragedy. Declaring it an emergency gives law enforcement and other agencies tasked with handling the crisis greater leeway and flexibility in their efforts, in fact, he recently renewed this declaration for another 90 days.
While this epidemic touches citizens and families across all socioeconomic boundaries, one Pennsylvania group that has been hit particularly hard by addiction are underprivileged populations that live in rural areas. These people often face obstacles in getting treatment for substance abuse issues ranging from lack of transportation to the lack of available programs and maybe even more importantly, treatment centers. While steps have been taken to address these issues, greater legislative action will be needed to ensure those in rural areas do not get left behind in the fight against opioids.
Pennsylvania Opioid Statistics
From 2015 to 2016, the state saw a stunning 30 percent surge in drug-related overdose deaths, according to a study by Overdose Free PA. Young adults are suffering disproportionately in this epidemic. People ages 25-34 accounted for nearly one-third of those deaths, even though they make up only 15 percent of the state’s population.
In rural areas the impact of the problem is even more devastating, drug overdose deaths in rural counties have surged by 42 percent, compared to 34 percent for urban counties, the study found. Again, these communities have a more difficult time accessing remedy and treatment.
Obstacles to Fighting the Pennsylvania Drug Problem in Rural Areas
Legislators want the constituents they represent to get the help they need in the fight against the drug epidemic, and that means facilitating ways for the afflicted to seek treatment for their addictions. Programs such as Medicaid are extremely important for individuals who don’t have the financial resources to access treatment independently. It is also crucial that centers to assist are in close enough proximity so that help is attainable.
State laws require that counties operate at least two treatment centers where patients on Medicaid can seek treatment within a 30-minute one-way drive in urban areas. However, that regulation expands to a 60-minute one-way drive for rural areas.
While it’s important that legislators are mandating treatment centers be available across the state, improvement is still needed to minimize the disparity of access to care within urban vs rural communities. Rural Pennsylvanians, some already at odds with economic disadvantages, are being asked to travel twice as long as those in urban communities, resulting in many patients never accessing the treatment they need. Thus, leading to the significantly higher number of deaths in rural counties.
As things are today, local treatment centers that can accept Medicaid still remain out of realistic reach for many in rural areas.
Studies have shown that the longer the travel time to a treatment center, the lower the patient participation in counseling and treatment. In other words, if the nearest treatment center takes an hour to get to, many people in rural areas simply don’t have the time or means of transportation to get there, for a variety of reasons. It’s hard enough to get an addict into a treatment center of close proximity, let alone require them to travel up to two hours round trip commute to get help.
Long travel times can:
- Make it next to impossible for an underprivileged person to hold down a job, due to difficulty balancing working with the time required to travel (two hours per day not included treatment time) and receive treatment
- Provide obstacles to taking care of a family, such as making dinner and helping with homework, while trying to manage the time required to seek counseling and treatment
- Incur child care costs for the commute and treatment time that are additional financial burdens on patients that just don’t have the income
Addressing the Obstacles to Treating the Pennsylvania Opioid Epidemic
What is the state government doing currently to help ease the burden? The state has regulations that attempt to help underprivileged people living in rural areas to access treatment. For instance, counties are mandated to provide transportation for patients who cannot access their treatment on their own. However, this policy has limitations because counties have the authority, under these regulations to determine the number and locations of substance abuse treatment centers that are available. As long as the county can find a treatment center within the 60 mile radius, they are in compliance. Remember, the longer the distance to the treatment center the higher the cost to the taxpayer, and the less likely that patients will receive treatment. Pennsylvania do better.
Changes That Should Be Made to Help Get Rural Patients Treatment
In full disclosure, Pugliese Associates represents New Season, which is the second largest provider of substance abuse treatment centers in the country, with facilities in 21 states. For instance, New Season has a quality facility in Uniontown, PA, but because of two other facilities, the minimum required, already approved by Fayette County within the 60 minute travel radius, New Season is prohibited from accepting and helping Medicaid patients that may very well be living next door. In fact, prospective patients are required to drive past the facility and travel significantly further away for treatment.
We need to rapidly mitigate this problem and provide better access for patients who need it most and those in rural areas, suffering a disproportionate amount of overdose deaths. Two solutions present themselves. First, the minimum number of county approved treatment centers must be increased, at least by requiring the minimum number be increased to three to give patients more access and choice. Additionally, the travel distance time in rural areas needs to be reduced in those rural counties where treatment centers exist within a thirty minute travel time period.
Time is of the Essence
With the severity of the opioid epidemic worsening each day and public health risks at an all-time high, changes should be made to current policies now in order to make treatment more accessible to the rural, underprivileged and lower-income residents of Pennsylvania.
As the Pennsylvania Legislature looks for ways to remedy this serious and growing crisis, these proposals should be at the top of the list of legislative changes. Making treatment more accessible will help the neediest of Pennsylvanians dramatically. Our counties and the state need to acknowledge the depth and breadth of this crisis. These common-sense changes to existing laws will expedite cure by providing better availability for treatment and relief for Pennsylvanian communities.