Sage Journals: Discover world-class research

Abstract

Medication-assisted treatment (MAT) for opioid use disorder (OUD) is accessed half as often in rural versus urban areas in the United States. To better understand this disparity, we used a qualitative descriptive approach to explore the experiences of individuals with OUD seeking MAT in rural New Mexico. Guided interviews were conducted with 20 participants. The frameworks of critical social theory, intersectionality theory, and the brain opioid theory of social attachment were used to guide data analysis and interpretation. Thematic content analysis derived five major themes which identified novel barriers and facilitators to MAT success, including a perceived gender disparity in obtaining MAT, challenges in building a recovery-oriented support system, and the importance of navigating a new normal social identity. This deeper knowledge of the experiences and perspectives of rural individuals with OUD could serve to address the rural–urban MAT disparity, leading to enhanced recovery capacity and transformative policies.

Keywords

opioid use disorder medication-assisted treatment rural health health care disparities qualitative description New Mexico

Get full access to this article

View all access options for this article.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.

American Society of Addiction Medicine. (2015). The national practice guideline for the use of medications in the treatment of addiction involving opioid use. https://www.asam.org/docs/default-source/practice-support/guidelines-and-consensus-docs/asam-national-practice-guideline-supplement.pdf

Andrilla

C. H. A.

Coulthard

Larson

E. H.

(2017). Barriers rural physicians face prescribing buprenorphine for opioid use disorder. The Annals of Family Medicine, 15(4), 359–362. https://doi.org/10.1370/afm.2099

Andrilla

C. H. A.

Moore

T. E.

Patterson

D. G.

(2019). Overcoming barriers to prescribing buprenorphine for the treatment of opioid use disorder: Recommendations from rural physicians. The Journal of Rural Health, 35, 113–121. https://doi.org/10.1111/jrh.12328

Ashford

R. D.

Brown

A. M.

Curtis

(2018). Substance use, recovery, and linguistics: The impact of word choice on explicit and implicit bias. Drug and Alcohol Dependence, 189, 131–138. https://doi.org/10.1016/j.drugalcdep.2018.05.005

Barry

C. L.

McGinty

E. E.

Pescosolido

B. A.

Goldman

H. H.

(2014). Stigma, discrimination, treatment effectiveness, and policy: Public views about drug addiction and mental illness. Psychiatric Services, 65(10), 1269–1272. https://doi.org/10.1176/appi.ps.201400140

Bart

(2012). Maintenance medication for opiate addiction: The foundation of recovery. Journal of Addictive Diseases, 31(3), 207–225. https://doi.org/10.1080/10550887.2012.694598

Brady

K. T.

McCauley

J. L.

Back

S. E.

(2016). Prescription opioid misuse, abuse, and treatment in the United States: An update. American Journal of Psychiatry, 173(1), 18–26. https://doi.org/10.1176/appi.ajp.2015.15020262

Carbado

D. W.

Crenshaw

K. W.

Mays

V. M.

Tomlinson

(2013). Intersectionality: Mapping the movements of a theory. Du Bois Review: Social Science Research on Race, 10(2), 303–312. https://doi.org/10.1017/S1742058x13000349

10.

Carroll

J. J.

Rich

J. D.

Green

T. C.

(2018). The more things change: Buprenorphine/naloxone diversion continues while treatment remains inaccessible. Journal of Addiction Medicine, 12(6), 459–465. https://doi.org/10.1097/ADM.0000000000000436

11.

Cicero

T. J.

Kuehn

B. M.

(2014). Driven by prescription drug abuse, heroin use increases among suburban and rural whites. Journal of the American Medical Association, 312(2), 118–119. https://doi.org/10.1001/jama.2014.7404

12.

Crenshaw

K. W.

(1991). Mapping the margins: Intersectionality, identity politics and violence against women of color. Stanford Law Review, 43(6), 1241–1299. http://www.jstor.org/stable/1229039

13.

Creswell

J. W.

(2013). Qualitative inquiry and research design: Choosing among five approaches (3rd ed.). Sage.

14.

Dennis

B. B.

Roshanov

P. S.

Naji

Bawor

Paul

Plater

… Thabane

(2015). Opioid substitution and antagonist therapy trials exclude the common addiction patient: A systematic review and analysis of eligibility criteria. Trials, 16, Article 475. https://doi.org/10.1186/s13063-015-0942-4

15.

Dick

A. W.

Pacula

R. L.

Gordon

A. J.

Sorbero

Burns

R. M.

Leslie

Stein

B. D.

(2015). Increasing potential access to opioid agonist treatment in U.S. treatment shortage areas. Health Affairs, 34(6), 1028–1034. https://doi.org/10.1377/hlthaff.2014.1205

16.

Dingle

G. A.

Cruwys

Frings

(2015). Social identities as pathways into and out of addiction. Frontiers in Psychology, 6, Article 1795. https://doi.org/10.3389/fpsyg.2015.01795

17.

Draus

Roddy

Asabigi

(2015). Making sense of the transition from the Detroit streets to drug treatment. Qualitative Health Research, 25(2), 228–240. https://doi.org/10.1177/1049732314552454

18.

Florence

J. E.

Pack

R. P.

Southerland

Wykoff

R. F.

(2012). The depth of rural health disparities in America: The ABCDEs. In Crosby

R. A.

Vanderpool

R. C.

Wendel

M. L.

Casey

B. R.

(Eds.), Rural populations and health: Determinants, disparities and solutions (pp. 51–71). Jossey-Bass.

19.

Garcia

(2010). The pastoral clinic: Addiction and dispossession along the Rio Grande. University of California Press.

20.

Gryczynski

Schwartz

R. P.

Salkever

D. S.

Mitchell

S. G.

Jaffe

J. H.

(2011). Patterns in admission delays to outpatient methadone treatment in the United States. Journal of Substance Abuse Treatment, 41(4), 431–439. https://doi.org/10.1016/j.jsat.2011.06.005

21.

Hansen

Siegel

Wanderling

DiRocco

(2016). Buprenorphine and methadone treatment for opioid dependence by income, ethnicity and race of neighborhoods in New York City. Drug and Alcohol Dependence, 164, 14–21. https://doi.org/10.1016/j.drugalcdep.2016.03.028

22.

Health Resources and Services Administration. (2017). Defining rural population. https://www.hrsa.gov/rural-health/about-us/definition/index.html

23.

Hewell

V. M.

Vasquez

A. R.

Rivkin

I. D.

(2017). Systemic and individual factors in the buprenorphine treatment-seeking process: A qualitative study. Substance Abuse Treatment, Prevention, and Policy, 12(1), 3. https://doi.org/10.1186/s13011-016-0085-y

24.

Hsieh

H. F.

Shannon

S. E.

(2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277–1288. https://doi.org/10.1177/1049732305276687

25.

Inagaki

T. K.

Ray

L. A.

Irwin

M. R.

Way

B. M.

Eisenberger

N. I.

(2016). Opioids and social bonding: Naltrexone reduces feelings of social connection. Social Cognitive and Affective Neuroscience, 11(5), 728–735. https://doi.org/10.1093/scan/nsw006

26.

Jones

C. M.

Campopiano

Baldwin

McCance-Katz

(2015). National and state treatment need and capacity for opioid agonist medication-assisted treatment. American Journal of Public Health, 105, e55–e63. https://doi.org/10.2105/AJPH.2015.302664

27.

Keane

Egan

J. E.

Hawk

(2018). Effects of naloxone distribution to likely bystanders: Results of an agent-based model. International Journal of Drug Policy, 55, 61–69. https://doi.org/10.1016/j.drugpo.2018.02.008

28.

Keyes

K. M.

Cerda

Brady

J. E.

Havens

J. R.

Galea

(2014). Understanding the rural-urban differences in nonmedical prescription opioid use and abuse in the United States. American Journal of Public Health, 104(2), e52–e59. https://doi.org/10.2105/AJPH.2013.301709

29.

Kincheloe

J. K.

McLaren

Steinberg

S. R.

(2011). Critical pedagogy and qualitative research. In Denzin

N. K.

Lincoln

Y. S.

(Eds.), The SAGE handbook of qualitative research (pp. 163–178). Sage.

30.

Klaman

S. L.

Isaacs

Leopold

Perpich

Hayashi

Vender

… Jones

H. E.

(2017). Treating women who are pregnant and parenting for opioid use disorder and the concurrent care of their infants and children: Literature review to support national guidance. Journal of Addiction Medicine, 11(3), 178–190. https://doi.org/10.1097/ADM.0000000000000308

31.

Komaromy

Duhigg

Metcalf

Carlson

Kalishman

Hayes

… Arora

(2016). Project ECHO (Extension for Community Healthcare Outcomes): A new model for educating primary care providers about treatment of substance use disorders. Substance Abuse, 37(1), 20–24. https://doi.org/10.1080/08897077.2015.1129388

32.

Kramlich

Kronk

Marcellus

Colbert

Jakub

(2018). Rural postpartum women with substance use disorders. Qualitative Health Research, 28(9), 1449–1461. https://doi.org/10.1177/1049732318765720

33.

Krawczyk

Negron

Nieto

Agus

Fingerhood

M. I.

(2018). Overcoming medication stigma in peer recovery: A new paradigm. Substance Abuse, 39, 404–409. https://doi.org/10.1080/08897077.2018.1439798

34.

Krefting

(1991). Rigor in qualitative research: The assessment of trustworthiness. American Journal of Occupational Therapy, 45(3), 214–222. http://www.ncbi.nlm.nih.gov/pubmed/2031523

35.

Lin

L. A.

Lofwall

M. R.

Walsh

S. L.

Gordon

A. J.

Knudsen

H. K.

(2018). Perceptions and practices addressing diversion among U.S. buprenorphine prescribers. Drug and Alcohol Dependence, 186, 147–153. https://doi.org/10.1016/j.drugalcdep.2018.01.015

36.

Lister

J. J.

Weaver

Ellis

J. D.

Himle

J. A.

Ledgerwood

D. M.

(2020). A systematic review of rural-specific barriers to medication treatment for opioid use disorder in the United States. American Journal of Drug and Alcohol Abuse, 46(3), 273–288. https://doi.org/10.1080/00952990.2019.1694536

37.

Machin

A. J.

Dunbar

R. I. M.

(2011). The brain opioid theory of social attachment: A review of the evidence. Behaviour, 148, 985–1025.

38.

Mack

K. A.

Jones

C. M.

Ballesteros

M. F.

(2017). Illicit drug use, illicit drug use disorders, and drug overdose deaths in metropolitan and nonmetropolitan areas—United States. MMWR Morbidity and Mortality Weekly Report, 66(19), 1–12. https://doi.org/10.15585/mmwr.ss6619a1

39.

Mattson

C. L.

O’Donnell

Kariisa

Seth

Scholl

Gladden

R. M.

(2018). Opportunities to prevent overdose deaths involving prescription and illicit opioids, 11 States, July 2016-June 2017. MMWR Morbidity and Mortality Weekly Report, 67(34), 945–951. https://doi.org/10.15585/mmwr.mm6734a2

40.

McCance-Katz

E. F.

(2018). SAMHSA/HHS: An update on the opioid crisis. https://www.samhsa.gov/sites/default/files/aatod_2018_final.pdf

41.

Meyer

Patel

A. M.

Rattana

S. K.

Quock

T. P.

Mody

S. H.

(2014). Prescription opioid abuse: A literature review of the clinical and economic burden in the United States. Population Health Management, 17(6), 372–387. https://doi.org/10.1089/pop.2013.0098

42.

Monnat

S. M.

Rigg

K. K.

(2016). Examining rural/urban differences in prescription opioid misuse among U.S. adolescents. Journal of Rural Health, 32(2), 204–218. https://doi.org/10.1111/jrh.12141

43.

Narcotics Anonymous. (2016). Narcotics anonymous and persons receiving medication-assisted treatment. https://www.na.org/admin/include/spaw2/uploads/pdf/pr/2306__PRMAT_1021.pdf

44.

National Institute on Drug Abuse. (2016). Effective treatments for opioid addiction. https://www.drugabuse.gov/publications/effective-treatments-opioid-addiction/effective-treatments-opioid-addiction

45.

Netherland

(2012). Introduction: Sociology and the shifting landscape of addiction. In Netherland

(Ed.), Critical perspectives on addiction (Vol. 14, pp. xi–xxiii). Emerald.

46.

New Mexico Department of Health. (2017). New Mexico’s Indicator-Based Information System (NM-IBIS). https://ibis.health.state.nm.us/indicator/view/DrugOverdoseDth.Cnty.html

47.

Nocjar

Panksepp

(2007). Prior morphine experience induces long-term increases in social interest and in appetitive behavior for natural reward. Behavioural Brain Research, 181(2), 191–199. https://doi.org/10.1016/j.bbr.2007.04.004

48.

Oliva

E. M.

Maisel

N. C.

Gordon

A. J.

Harris

A. H.

(2011). Barriers to use of pharmacotherapy for addiction disorders and how to overcome them. Current Psychiatry Reports, 13(5), 374–381. https://doi.org/10.1007/s11920-011-0222-2

49.

Patton

M. Q.

(2015). Qualitative research & evaluation methods: Integrating theory and practice (4th ed.). Sage.

50.

Pullen

Oser

(2014). Barriers to substance abuse treatment in rural and urban communities: Counselor perspectives. Substance Use & Misuse, 49(7), 891–901. https://doi.org/10.3109/10826084.2014.891615

51.

Rhodes

(2002). The “risk environment”: A framework for understanding and reducing drug-related harm. International Journal of Drug Policy, 13, 85–94.

52.

Rhodes

(2009). Risk environments and drug harms: A social science for harm reduction approach. International Journal of Drug Policy, 20(3), 193–201. https://doi.org/10.1016/j.drugpo.2008.10.003

53.

Rosenblatt

R. A.

Andrilla

C. H.

Catlin

Larson

E. H.

(2015). Geographic and specialty distribution of U.S. physicians trained to treat opioid use disorder. Annals of Family Medicine, 13(1), 23–26. https://doi.org/10.1370/afm.1735

54.

Rossen

L. M.

Bastian

Warner

Khan

Chong

(2017). Drug poisoning mortality in the United States, 1999-2016. https://www.cdc.gov/nchs/data-visualization/drug-poisoning-mortality/

55.

Rozanova

Marcus

Taxman

F. S.

Bojko

M. J.

Madden

Farnum

S. O.

… Altice

F. L.

(2017). Why people who inject drugs voluntarily transition off methadone in Ukraine. Qualitative Health Research, 27(13), 2057–2070. https://doi.org/10.1177/1049732317732307

56.

Sandelowski

(2000). Whatever happened to qualitative description? Research in Nursing & Health, 23(4), 334–340. https://www.ncbi.nlm.nih.gov/pubmed/10940958

57.

Sandelowski

(2010). What’s in a name? Qualitative description revisited. Research in Nursing & Health, 33(1), 77–84. https://doi.org/10.1002/nur.20362

58.

Scholl

Puja

Mbabazi

Wilson

Baldwin

(2019). Drug and opioid-involved overdose deaths—United States, 2013–2017. MMWR Morbidity and Mortality Weekly Report, 67, 1419–1427. https://www.cdc.gov/mmwr/volumes/67/wr/mm675152e1.htm

59.

Schuman-Olivier

Albanese

Nelson

S. E.

Roland

Puopolo

Klinker

Shaffer

H. J.

(2010). Self-treatment: Illicit buprenorphine use by opioid-dependent treatment seekers. Journal of Substance Abuse Treatment, 39(1), 41–50. https://doi.org/10.1016/j.jsat.2010.03.014

60.

Short

V. L.

Hand

D. J.

MacAfee

Abatemarco

D. J.

Terplan

(2018). Trends and disparities in receipt of pharmacotherapy among pregnant women in publically funded treatment programs for opioid use disorder in the United States. Journal of Substance Abuse Treatment, 89, 67–74. https://doi.org/10.1016/j.jsat.2018.04.003

61.

Sigmon

S. C.

(2014). Access to treatment for opioid dependence in rural America: Challenges and future directions. JAMA Psychiatry, 71(4), 359–360. https://doi.org/10.1001/jamapsychiatry.2013.4450

62.

Strang

Volkow

N. D.

Degenhardt

Hickman

Johnson

Koob

G. F.

… Walsh

S. L.

(2020). Opioid use disorder. Nature Reviews Disease Primers, 6(1), 3. https://doi.org/10.1038/s41572-019-0137-5

63.

Substance Abuse and Mental Health Services Administration. (2016). Treatments for substance use disorders. https://www.samhsa.gov/treatment/substance-use-disorders

64.

Thomas

Magilvy

J. K.

(2011). Qualitative rigor or research validity in qualitative research. Journal for Specialists in Pediatric Nursing, 16(2), 151–155. https://doi.org/10.1111/j.1744-6155.2011.00283.x

65.

Thorne

S. E.

(2000). Data analysis in qualitative research. Evidence-Based Nursing, 3(3), 68–70.

66.

Thorne

S. E.

(2008). Interpretive description. Left Coast Press.

67.

Trujillo

M. L.

(2009). Land of disenchantment: Latina/o identities and transformations in northern New Mexico. University of New Mexico Press.

68.

U.S. Census Bureau. (2016). Quick facts: New Mexico. https://www.census.gov/quickfacts/fact/table/NM,US/PST045216

69.

U.S. Department of Health and Human Services. (2012). Healthy people 2020. https://www.healthypeople.gov

70.

White

W. L.

(2011). Narcotics anonymous and the pharmacotherapeutic treatment of opioid addiction in the United States. https://www.atforum.com/documents/2011andMedication-assistedTreatment.pdf

71.

Wilson

Shaw

M. R.

Roberts

M. L. A.

(2018). Opioid initiation to substance use treatment: “They just want to feel normal.” Nursing Research, 67(5), 369–378. https://doi.org/10.1097/NNR.0000000000000298

72.

World Health Organization. (2017). Treatment of opioid dependence. http://www.who.int/substance_abuse/activities/treatment_opioid_dependence/en/

73.

Yarborough

B. J.

Stumbo

S. P.

McCarty

Mertens

Weisner

Green

C. A.

(2016). Methadone, buprenorphine and preferences for opioid agonist treatment: A qualitative analysis. Drug & Alcohol Dependence, 160, 112–118. https://doi.org/10.1016/j.drugalcdep.2015.12.031

74.

Zellner

M. R.

Watt

D. F.

Solms

Panksepp

(2011). Affective neuroscientific and neuropsychoanalytic approaches to two intractable psychiatric problems: Why depression feels so bad and what addicts really want. Neuroscience & Biobehavioral Reviews, 35(9), 2000–2008. https://doi.org/10.1016/j.neubiorev.2011.01.003

75.

Zentella

(2004). Land loss among the Hispanos in Northern New Mexico: Unfinished psychological business. Journal of Social Work in the Social Environment, 9(3), 83–103.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.01 MB

Overcoming Barriers: Individual Experiences Obtaining Medication-Assisted Treatment for Opioid Use Disorder

Abstract

Keywords

Get full access to this article

References

Supplementary Material