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Differing perceptions of the opioid crisis among metropolitan and rural communities

Study findings highlight the importance of tailoring prevention and mitigation efforts to address opioid use disorder in urban and rural areas

For the first time, overdose deaths in the United States topped over 100,000 in the 12-month period ending in April 2021, according to the Centers for Disease Control and Prevention (CDC). Opioids including fentanyl are responsible for a majority of these deaths. With the recent influx of illicitly manufactured fentanyl and increased polysubstance use, drug-related mortality has increased dramatically. The latest public data from the CDC indicates that reported overdose deaths in Texas involving fentanyl increased 399 percent in the last two fiscal years.

A new study published in Preventive Medicine Reports examined urban/metropolitan and rural differences in concerns about opioids, opioid misuse and strategies to reduce opioid use disorder risk in Central Texas. It found that although the majority of urban and rural respondents were concerned about opioid misuse, those in rural areas were less likely to perceive that individuals were receiving needed treatment and were less likely to support legalizing syringe exchange programs.

This research addresses many of the nine key Initiatives for combatting the opioid crisis promoted by the Texas A&M University Opioid Task Force co-chaired by Marcia G. Ory, PhD, lead author of this study, and Joy P. Alonzo, ME, PharmD, from the Texas A&M College of Pharmacy.

“Of particular interest is examining metropolitan-rural differences in awareness of individuals affected by opioid use in the community, concerns about the opioid crisis, perceived likelihood of getting substance use disorder treatment, and support for various harm reduction strategies,” said Ory, who is a Regents and Distinguished Professor in Environmental and Occupational Health at the Texas A&M University School of Public Health and faculty affiliate of the Texas A&M Health Center for Population Health and Aging.

Using data from the Brazos Valley Regional Health Assessment collected in 2019, the researchers analyzed a target sample of 700 respondents who were 18 years or older living in eight Central Texas counties (Austin, Brazos, Burleson, Grimes, Leon, Madison, Roberston, Washington) and spoke, read or wrote English or Spanish at a seventh-grade level. Of the identified counties three were classified as metropolitan and five as rural. In addition to their sociodemographic characteristics, respondents were asked about how many people they knew in their communities who were misusing opioids as well as their perceived concerns about the opioid crisis in their communities. Furthermore, they were asked about the perceived likelihood of people getting treatment for opioid use disorder in their communities as well as their support for strategies to reduce opioid use disorder risks.

“About 60 percent of rural and metropolitan respondents were concerned about opioid use and misuse in their community. However, rural respondents were significantly less likely to perceive that those individuals are getting the needed opioid use disorder treatment,” Ory said. “Rural respondents were also significantly less supportive for legalizing syringe exchange programs in their communities than metropolitan respondents. Differing attitudes by respondents from metropolitan and rural areas indicate the importance of tailoring prevention and mitigation efforts to address opioid use disorder in advance of an impending public health crisis.”

The authors noted that little is known about opioid use disorder treatment in rural areas in Texas and that more research is needed to learn more about the low utilization of care as well as the treatments offered.

Based on their findings the researchers also outlined four recommendations for future action: 1) increase education for health care providers regarding substance use disorder treatment modalities and resources for referral to treatment providers, 2) develop safe drug ordinances and disposal sites, 3) provide naloxone training and naloxone rescue kits to willing persons, and 4) reduce stigmas about and legalize and proliferate syringe exchange programs.

“Understanding community awareness and attitudes towards the opioid crisis and potential harm reduction strategies can provide valuable insights to local policymakers and public health practitioners attempting to address the problem,” Alonzo said.

“With the opioid epidemic rapidly evolving, additional research on temporal patterns of the epidemic and attitudes among a broader population, which include both high and non-high risk urban and rural areas, is recommended,” concludes Ory.

Additional authors from the School of Public Health included Shinduk Lee, DrPH; Matthew Lee Smith, PhD, MPH; Heather Clark, DrPH, MSPH; and James N. Burdine, DrPH.

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