Substance addiction does not discriminate, it doesn’t consider a person’s age, gender or social status. Addiction can affect anyone. Many Americans know someone — a family member, friend, co-worker — who has been impacted by a substance use disorder (SUD). Furthermore, many people know of a person who has died from an overdose. The national overdose death rate has increased significantly over the past few years and this is in part due to the opioid epidemic. In fact, more people currently die of drug overdoses than from car accidents. The death rate is so shocking that it prompted numerous federal and state organizations to search for answers as to why this is occurring on such a large scale.

Research suggests that the areas with the highest overdose death rates are rural areas with high poverty levels. However, there are possibly other variables that cause increased rates of overdoses in more affluent regions like New Hampshire — which is third in the top 10 states with the most overdose death rates, according to the Center for Disease Control and Prevention (CDC). It’s difficult to believe that a state that often lands near the top of “Best Places to Live” lists, and has low spending on preventative and substance treatment programs contributes to a high overdose death rate. Some people with an SUD admit to giving up on seeking treatment, citing that there are too many obstacles and constraints.  

In the New England area, New Hampshire has the lowest per-capita spending for substance treatment and is second-lowest in the nation, behind Texas. A similar pattern of spending little on treatment exists in West Virginia, which is the state with the most overdose deaths in the country.

When Treatment Isn’t Accessible

In 2016, about 21 million people needed substance use treatment, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). In other words, 1 in 13 people needed to be treated for a SUD, but only 2.2 million — 10.6 percent — of those struggling with a SUD actually received treatment at a rehabilitation facility. In 2016, 38 percent of all counties in the United States did not have any SUD treatment facilities and access to treatment was particularly difficult for people in rural regions.

Research suggests that increasing access to rehabilitation facilities can reduce the rate of drug overdose deaths. For example, many counties in different parts of the country have high overdose death rates compared to the rest of the United States and do not have a single standalone SUD treatment facility. This is especially noticeable in rural areas. While having more rehab facilities correlates with having a lower drug overdose rate, this doesn’t solve the issue for affected individuals living in rural areas with no local options for treatment.

A man dealing with addiction works through his emotions in a group counseling session.

Percentage of Residential Treatment Offered by State

Residential treatment, also known as inpatient rehabilitation, is often suggested to be the most effective method of addiction treatment and recovery. Residential treatment allows patients to detox within a facility and then receive treatment that may include individual therapy, group therapy, aftercare planning and more. This treatment is intense, but effective because it requires an extended time period for treatment. The change of environment also allows patients to remove themselves from harmful triggers that may cause them to want to misuse the substance they are addicted to.

According to the Substance Abuse and Mental Health Data Archive (SAMHDA), the top 10 states with highest overdose drug rates are on the lower end of states that offer residential treatment options. Less than half of the states’ total facilities offer inpatient programs. Out of all of Maine’s facilities, which is the state with the tenth highest overdose rate, just 12 percent of rehabilitation facilities offer residential treatment. All of the other states on the top 10 list are in the 20 percent range. New Hampshire, the third state on the list, is on the higher end of the range, with 36 percent of its treatment centers offering inpatient rehab. Massachusetts, the seventh state in the country with the most overdose deaths, has 39 percent of treatment facilities that offer residential treatment. These numbers reveal that while a decent amount of facilities do offer inpatient programs, the availability is still relatively low compared to the rest of the country. The population of the state and the amount of high-density, urbanized areas should also be taken into consideration when analyzing this data, since a state with a larger overall population will have more overdoses, in general, than a state with a smaller population.

For example, in New Hampshire, the availability of treatment is limited to more urban areas so those in need of treatment in rural regions often have to resort to local emergency rooms or fire stations. While these facilities can offer treatment to prevent overdoses, they can’t properly treat addiction so that the individual won’t misuse the substance again. Even though the percentage of residential treatment in Massachusetts is higher than the other states listed, the state’s facilities still experience long waitlists for treatment, up to at least three weeks — regarding residential facilities, the waitlist could be upward of three months. In addition to individuals not receiving the treatment they need, they are in some cases deciding to purchase illicit drugs like methadone and buprenorphine (substances often used for medically assisted therapies) to keep withdrawal symptoms at bay.

A red emergency room sign to guide those dealing with drug addiciton or overdose to the hospital.

Payments Accepted by Rehab Facilities

While residential treatment is often the most effective program for addiction treatment and recovery, it can also be the most expensive. Besides the lack of availability and access to treatment, the next barrier to treatment cited by people with a SUD was the cost. The inadequacy of health care coverage and cost constraints are other reasons people in the states with high overdose rates don’t seek treatment. Many of the states with the highest overdose rates were once states that profited off the production of coal — with the decline in usage of coal, many of the facilities that produced it closed and many residents in those areas lost their jobs. Coal-mining and other physically taxing jobs often result in injury. To numb the pain of the injuries and the aches from years of manual labor, some of these unemployed residents take painkillers. For that reason, these former coal miners may be at a higher risk for developing opioid use disorders than other workers. These areas are often rural and also are the areas with the scarcest rehab facilities.

Medicaid and Medicare

Because the unemployment rates and poverty levels can be high in these regions, the access to addiction treatment is often hindered by cost. Many of these residents who need SUD treatment rely on government-funded health insurance programs like Medicaid and Medicare for their healthcare costs. Nine out of the top 10 states with the highest overdose death rates are on the lower end of housing facilities that accept Medicaid. In Kentucky, the state with the fifth most overdose deaths, half of the rehab facilities accept Medicaid. Ohio and West Virginia are among the states with a low percentage of treatment facilities accepting assistance. Medicare, on the other hand, is largely accepted by over half of these states’ rehab centers.

Medicaid often covers more groups of people than Medicare — the lack of facilities that accept Medicaid as a payment option can demonstrate how and why people with SUDs and a low income can’t gain access to proper and effective addiction treatment. Private insurance isn’t accepted by over half of the top 10 states’ treatment centers with West Virginia’s accepting the least, at 13 percent. In addition to financial assistance, a person seeking addiction treatment could pay out of pocket — if they can find a facility that accepts private pay. Among the top 10 states with the most overdoses, the percentage of treatment facilities that accept private pay barely breaks double digits, with Kentucky, again, being among the lowest at five percent.

A stethoscope sits on a clipboard use to the help treat patients dealing with addiction or overdose.

State-Funded Insurance

While the percentage of many forms of payment accepted is less than half amid the top 10 states with the highest overdose death rates, the percentage of those facilities that accept state-funded health insurance is quite high. These 10 states, on the other hand, have treatment facilities that accept state-funded insurance. Kentucky is again the lowest for accepting state-funded insurance at 37 percent but compared to the other forms of payments accepted this is a fairly high percentage for the state’s rehab facilities. State-funded health insurance is often something that a person must qualify for and is mostly based on their income. Someone who does not have a low income (as determined by each state) is expected to pay the thousands of dollars it would cost to get the treatment they need —if they can find a rehabilitation facility that accepts private pay in their area.

The funding and access to treatment options play a significant role in an area’s drug problem. The top 10 states with the highest overdose death rates are among the states with the lowest access to treatment facilities, as well as facilities that can assist with the cost of treatment. Some specialists suggested that a person grappling with a SUD leave their home state and seek treatment in another county or even another state. This may enable the person to find more treatment options for themselves as well as better payment options that suit their financial situation. However, people that can’t afford treatment often can’t afford to leave their hometown. This is why states need to shift their funding priorities. They need more facilities with more rooms that can assist individuals that can’t afford the cost of inpatient programs. The evidence gathered suggests that increasing access to rehabilitation treatment facilities can reduce substance overdose deaths, especially in the rural regions that have been most affected by the opioid epidemic.

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