Rural Addicts Find Difficulty Accessing Treatment

Opioid-dependent adults who live in rural states, such as Vermont, are often put on long waiting lists to get into substance abuse treatment programs, increasing their risk of continuous use, contracting an infectious disease, overdosing, and/or premature death.

In fact, 48 of the states in the U.S. have opioid dependence rates that exceed medication-assisted treatment availability, according to a 2015 study in the American Journal of Public Health.

Vermont’s largest methadone clinic, the Chittenden Clinic Opioid Treatment Program in Burlington, recently increased capacity from 400 to 1,000 patients, but waitlists for treatment persist. Director of the clinic, Stacey Sigmon, Ph.D., is an addiction research expert with the Vermont Center on Behavior and Health, and she has seen the problem firsthand.

Sigmon conducted a study to test an “Interim Buprenorphine Treatment” (IBT) regimen for waitlisted opioid-dependent adults. The findings are published in the New England Journal of Medicine.

For the study, participants were randomized to receive IBT or continued “Waitlist Control” for three months. IBT participants received buprenorphine maintenance dispensed via a small computerized device, daily monitoring calls via an Interactive Voice Response (IVR) phone system, and IVR-generated random call-backs.

IBT participants made bi-weekly clinic visits for assessment, at which time urine specimens were collected under staff observation and analyzed immediately for opioids and other drugs.

Not only were IBT participants able to abstain more consistently from illicit opioid use, they also demonstrated greater reductions in their frequency of injection drug use and also in mental health symptoms, such as anxiety and depression.

Adherence with buprenorphine administration (99 percent), daily monitoring (96 percent), and random call-backs (96 percent) was also excellent, as were patients’ ratings of treatment satisfaction.

“This study represents a substantial first step towards the development of an interim dosing intervention that could reduce illicit drug use, injection drug use and other risk behaviors when a comprehensive treatment slot is unavailable,” said Sigmon.

“Finding a creative way to provide buprenorphine to waitlisted opioid abusers may greatly reduce individual and societal harm during delays to opioid treatment.”

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