Opioid Overdose Deaths

In a study of more than 3,000 counties across the U.S., the researchers found that residents of 412 counties are at least twice; as likely to be at high risk for opioid overdose deaths; and to lack providers who can deliver medications to treat opioid use disorder. States with among the most high-risk counties include: North Carolina, Ohio, Virginia, Kentucky, Michigan, Tennessee, Illinois, Indiana, Georgia, Oklahoma, West Virginia, South Carolina, Wisconsin and Florida.

However the study, publish in the issue of JAMA Network Open; suggests strategies for increasing treatment for opioid addiction, including by increasing the number of primary care clinicians capable of providing medications; as well as improving employment opportunities in those communities.

They hope policymakers can use this information to funnel additional money; and resources to specific counties within their states. We need more strategies to augment and increase the primary care provider workforce in those high-risk counties; people who are willing and able to provide opioid use disorder treatments.” Lead author Rebecca Haffajee, assistant professor of health management and policy at the U-M School of Public Health

Opioid overdose deaths

But the U-M researchers look at opioid overdose mortality rates in 3,142 U.S. counties between January 2015; and December 2017. They defined an opioid high-risk county as one with opioid overdose death; above the national rate and with the availability of providers to deliver opioid use disorder; medications below the national rate. The study, they say, is the first to include data from all three opioid use disorder medications on the market; including methadone, buprenorphine and naltrexone.

However, their analysis included publicly listed providers of methadone (1,517 opioid treatment programs); buprenorphine (24,851 clinicians approved to prescribe the medication) and the extended-release naltrexone product Vivitrol (5,222 health care providers, as compiled by the drug manufacturer). However, in their cross-sectional study; the researchers also looked at demographics, workforce, access to health care insurance; road density, urbanicity and opioid prescriptions.

Lower rates of unemployment

Among counties analyzed, they found that: 412 counties (13%) are classified as high-risk; having both high opioid overdose mortality and low treatment capacity. 751 counties (24%) had a high rate of opioid overdose mortality. 1,457 (46%) counties lacked a publicly available provider of opioid use disorder medication. 946 out of 1,328 rural counties (71%) lacked a publicly available provider of opioid use disorder medication.

But the study found that certain factors such as a younger population; lower rates of unemployment and higher density of primary care physicians are associated with a lower risk of opioid overdose death; and lack of capacity to treat opioid use disorder. Haffajee, also a member of the U-M Institute for Healthcare Policy and Innovation; said it’s important to understand the differences of the opioid epidemic at the local level.

“However, in rural areas, the opioid crisis is often still a prescription opioid issue. But in metropolitan counties, highly potent illicit fentanyl and other synthetic opioids are more prevalent and are killing people,” she said. “That’s likely why they identify metropolitan areas as higher-risk; despite the fact that these counties typically have some (just not enough) treatment providers.