Bridging the urban-rural divide for lifesaving substance abuse treatment

Imagine driving 75 miles one way every day because your life depended on it.

That used to be the case for residents of Redding, in Shasta County, who needed treatment for substance abuse disorder. They had no choice but to make the drive to Chico, in Butte County. 

In urban areas, they’d at least have a fighting chance. But in rural California — no such luck. In rural California, the rate of opioid-related deaths doubles, sometimes even triples, the average rate in urban counties. 

In the past year, the California Department of Health Care Services began funding the expansion of a mobile narcotic treatment program across the state, in which mobile units  travel to rural communities and provide medicine-assisted treatments to people with opioid use disorder. 

Rather than limiting treatment only to mobile units and to the occasional facility located in more urban areas, California needs to expand medicine-assisted treatment through “medication units” in rural communities. 

Med units are satellite offices of primary clinics licensed to treat recovering patients. 

While the mobile narcotic treatment program does an excellent job of directly bringing treatment to vulnerable populations by eliminating transportation and cost barriers, it is unrealistic to believe that mobile units can effectively treat the hundreds of thousands of rural Californians who suffer from opioid addiction. 

Practically speaking, mobile units only allow for one patient to be seen at a time, severely limiting how many patients can be treated at one location. 

There also are not enough clinics or facilities in rural California that offer medicine-assisted treatments. For example, in rural Butte County, which has one of the highest opioid-related death rates in the state, the county only has one facility in Chico that offers medicine-assisted treatment. 

Instead of forcing long distances on patients, state and local governments should coordinate to expand med units to more rural areas. 

In Redding, after a years-long approval process, Shasta County eventually built a med unit,   ending the hours-long commute for patients. The clinic grew so fast that it eventually became its own office within a few years. Now it’s larger than the Chico facility.

With sufficient time and funding, these med units will reassure recovering patients that the medicine-assisted treatments are here to stay and that there is support for patients should they want it.  

The larger question might be how the state plans to pay for this. 

With $1 billion dollars already invested in Governor Newsom’s Master Plan to tackle the opioid crisis, finding any pocket change in the budget will be difficult. That’s not mentioning the long and arduous bureaucratic challenges to approve new med units at the state and local levels. 

But it is worth the effort, if we consider how much supporting people in recovery leads to  improved health and wellbeing in our communities. 

It will lighten the strain on under-resourced emergency services and reduce the number of visits to hospital emergency rooms due to opioid overdoses, thus lowering the costs of healthcare.

It also will reinsert recovering patients into the workforce, thus reducing unemployment and reliance on welfare programs. 

Where does the Trump administration fit into this? Given that President Donald Trump is focused on cutting back  “waste,” one could argue that the last thing we need is an increase in expenditures, especially if we have other priorities that depend on California cooperating with the federal government. 

Yet we can’t dismiss the state’s responsibility to protect Californians from all dangers and threats, including faceless ones. If the state does not pursue expanding medicine-assisted treatments, then California will be complicit in or responsible for the lives lost to the opioid crisis. 

When the opioid epidemic strikes, it leaves no mercy — not to its victims and certainly not to their friends and families. 

While medicine-assisted treatment and substance abuse overall remain stigmatized — especially in rural communities — we cannot be distracted from the harm substance abuse perpetuates. 

Seeking help for an addiction should not be an arduous, 75-mile drive away.