Essays on the Rural Opioid Crisis

Abstract

Rural areas in the U.S. have been notably affected by the opioid crisis, resulting in higher rates of opioid-related deaths and misuse than their urban counterparts. This dissertation assesses the effectiveness of existing strategies aimed at reducing opioid misuse, and also describes an Extension-led effort to engage rural communities struggling with this issue. The first study focuses on opioid treatment programs (OTPs) in the South census region. Through coarsened exact matching (CEM), the study determines if OTP presence is associated with reductions in the opioid-related death rate in counties nearby the OTP. Rural and urban counties are analyzed separately, to see if the results vary for these different types of areas. The findings of this study suggest that OTPs are not negatively associated with future opioid-related deaths, in either rural or urban counties. The second study examines prescription drug monitoring programs (PDMPs), which are statewide online programs that monitor controlled substance prescriptions. Multiple correspondence analysis is used to create a measure of a state's PDMP robustness. The aim of this study is to evaluate if states with more stringent PDMPs in place are associated with increased incidences of illicit opioid deaths, due to prescription opioids being more difficult to obtain in these areas. Results show that continuous measures of PDMP strength are not generally associated with the prescription opioid- or heroin-related death rate. Yet, one model does confirm the hypothesis that stricter PDMPs are related to more illicit opioid use. When the PDMP scores are broken into quartiles in the models, only the lowest quartile of scores (i.e. least stringent) is seen to have a negative association with overdose deaths. For the third study, a series of three community meetings were held in Ardmore, Oklahoma. Community stakeholders attended these meetings, and a variety of data collection techniques assessed where they would like to direct future resources aimed at reducing opioid misuse in their area. The participants noted that they would like funding to go towards increasing access to opioid treatment options, and to youth education programs in their community.