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Differences in Barriers and Training Needs Identified by Rural and Rural-Serving Urban Providers

January 2, 2024
Meg Brunner, MLIS
Kriegal LS, et al. Addressing the spectrum of opioid misuse prevention, treatment, and recovery in rural Washington State communities: Provider identified barriers and needs. Community Mental Health Journal 2023 (in press). Read it for free online.
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Addiction Science Made Easy
February 2024
CTN Dissemination Library & Northwest ATTC


What’s the Question?Rural - Urban road sign in middle of farm field

Between 2002 to 2021, the rate of opioid overdose deaths in Washington State increased from 6.7 to 21.2/100,000 residents. The overdose crisis has significantly impacted rural communities in particular, with COVID-19 confounding that impact. Rural communities typically have limited access to health care, fewer health care providers with higher turnover, increased travel distances to care, little to no public transportation, lack of privacy, and increased stigma related to seeking or obtaining treatment, among other challenges. 

In response, many rural communities supplement care with outside providers, resources, and materials that may not be developed with rural culture in mind. 

SAMHSA’s Rural Opioid Technical Assistance (ROTA) program aims to “develop and disseminate training and technical assistance for rural communities on addressing opioid issues affecting these communities.” This study uses data from a SAMHSA-funded ROTA program in Washington State (the Center for Rural Opioid Prevention, Treatment, and Recovery, or CROP+TR) to identify similarities and differences between rural and urban based opioid prevention, treatment, and recovery providers serving rural communities that can help strengthen these partnerships and improve rural care.

How Was This Study Conducted?

Data were collected as part of a needs assessment survey CROP+TR administered to Washington-based opioid-related service providers (N=78). The survey was developed with the input of a community advisory board and administered virtually. It asked questions about basic demographics, as well as barriers to prevention, treatment, and recovery and professional development and support.  

What Did Researchers Find Out?

While rural and rural-serving urban providers were similar in many ways, there were some interesting differences. For example, while both sets of providers noted the same top 5 barriers (stigma, lack of community knowledge about opioid use disorder (OUD), access to services, access to prevention programs, and access to financial support for care), they differed quite a bit on the next 7, with lack of providers/high turnover being noted more often by rural providers, and inconsistent or lacking internet access to support telehealth services or training ranked higher by urban providers serving rural communities.

Another difference was related to training, with more rural providers than urban ones reporting receipt of training, and desire for more training, related to prevention (i.e., prevention strategies for youth, funding to prevent OUD). This may be explained by the fact rural communities often have fewer treatment options available, making prevention an approach they find more effective and accessible.

What Are the Implications for the Workforce?

The differences between rural and rural-serving urban providers showcase the ways in which rural-urban partnerships can be strengthened to enhance care. Despite serving the same population, these two groups have different opinions about barriers and training needs and foci. These differences suggest that providers would benefit from training determined not only by skill-related needs but also according to environmental conditions like rurality. In order to better support these necessary partnerships, these results stress the importance of considering where providers and clients live when considering and refining training content.


Read it for free online.