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Patients with Multiple SUDs in Rural Settings Receive More Healthcare Services Than Those with OUD Only

January 1, 2024
Meg Bruner, MLIS
Zhu Y, et al. Co-occurring substance use disorders among patients with opioid use disorder in rural primary care clinics. Journal of Substance Use and Addiction Treatment 2024;158:209269.
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Addiction Science Made Easy
January 2024
CTN Dissemination Library & Northwest ATTC


What’s the Question?

country roadThe overdose crisis continues to be a major public health issue in the U.S., with nearly 80,000 deaths involving opioids reported in 2022. Most opioid-involved overdose deaths also involved other substances, especially stimulants like cocaine or methamphetamine. 

People with opioid use disorder (OUD) often have another, co-occurring substance use disorder (SUD), with recent studies finding that rate as high as 26-57%. Having a co-occurring SUD is associated with greater health effects, higher risk of a return to use following treatment, overdose, and death.

Rural areas have disproportionately high rates of opioid overdose deaths due to a range of factors, including limited healthcare resources and challenges related to access, like lack of transportation and high levels of stigma. 

There’s also evidence that access to medications for opioid use disorder (MOUD), the most effective treatment for OUD, differs for people with OUD plus another SUD compared to those with OUD alone. Some studies have found that patients with OUD plus another SUD are less likely to receive MOUD, while other studies have found that they’re more likely.

Combine these two elements and we know even less – what about the difference in treatment between patients with OUD plus another SUD and those with OUD only in rural settings specifically? That’s the question this study team sought to answer.

How Was This Study Conducted?

For this project, researchers used electronic health record data from National Drug Abuse Treatment Clinical Trials Network study CTN-0102, which was a feasibility study that aimed to expand access to MOUD treatment using a both care coordination and telemedicine approaches. The original trial was conducted in six rural sites in Maine, Washington, and Idaho. 

Researchers for this study organized the study sample into 3 groups: 1) people with OUD and no other SUDs (OUD-only), 2) people with OUD and at least stimulant use disorder (OUD + StUD), and 3) people with OUD and other non-stimulant use disorder (OUD + Other).

Analysis revealed 1164 patients with OUD; 72.6% were OUD-only, 11.5% were OUT+StUD, and 15.9% were OUD+Other.

What Did Researchers Find Out?

Researchers discovered that the OUD+StUD group had the highest rates of hepatitis C virus (25.4% for OUD+StUD, 17.8% for OUD+Other, and 7.5% for OUD-only) and the highest rates of mental health disorders (78.4%, 69.7%, and 59.9% respectively).

Compared to the OUD-only group, patients in the OUD+StuD and OUD+Other groups were more likely to receive healthcare services – specifically, in the case of this study, telehealth services (including provision of MOUD) provided by clinic staff, in-clinic behavioral health services, and in-clinic MOUD. 

Co-occurring SUDs were also associated with younger age and being uninsured, two pieces of demographic information that clinicians could use to help identify patients who might be most at risk for multiple use disorders.

What Are the Implications for the Workforce?

Given the results of this study, which found that individuals with multiple SUDs were more likely to have additional health and mental health conditions, more efforts to address barriers to care for patients at high risk for multiple SUDs should be considered, particularly in rural settings where those barriers can be much more significant. Comorbid SUDs and mental health conditions are associated with greater SUD severity and worse treatment outcomes, making this a particularly high-risk group.

The high use of telehealth services in these rural primary care clinics, particularly by those who had multiple SUDs, also suggests that technology-based approaches to delivering care could be effectively used to expand access to treatment for people with OUD in rural settings. To learn more about the original CTN study, Rural Expansion of Medication Treatment for Opioid Use Disorder (CTN-0102), visit the CTN Dissemination Library.


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