Removing Barriers on the Road to Recovery
Rural Opioid and Direct Support Services (ROADSS) for Methadone Maintenance Treatment
For people with substance use disorder (SUD), the road to recovery can be long and hard. And in rural communities, where rates of overdose mortality have increased at higher rates than in urban areas,1 limited access to treatment makes the journey even more difficult. The ROADSS program addresses that disparity by bringing treatment and resources that have been proven to save lives closer to home.
In Appalachian communities opioid overdose deaths have been at a higher rate than in urban communities. Yet the people in those communities face much greater barriers to accessing treatment. The ROADSS model is a way of making that treatment more accessible in addressing that disparity. Methadone maintenance treatment can reduce overdose rates by 50 percent or more.
It can also reduce infection rates, crime rates, and illicit drug use; improve retention in treatment; and in some instances, also improve employment rates in some communities. To a person with opioid use disorder medication assisted treatment like methadone maintenance can make all the difference. Say you're a person with an opioid use disorder and require methadone maintenance treatment. The nearest clinic could be hours away.
In methadone maintenance treatment the medication regimen requires sometimes six or seven days a week dispensing. When someone first starts treatment that is the frequency, and if a clinic is two hours away someone could be spending four hours of their day just to get back and forth to and from treatment. How can you maintain your obligations to work and your family with that kind of time commitment? Without the ROADSS program, providers face a lot of barriers in trying to open a new OTP.
It's a highly regulated treatment modality that has very specific regulatory requirements, staffing requirements, and financial burdens for providers trying to open a new program. The ROADSS program features a partnership between an opioid treatment program (or OTP), which may be in an urban location, and rural organizations outside of metropolitan areas. The OTP serves as a central location offering a range of services including methadone prescribing, methadone dispensing, telehealth, counseling, provider-to-provider consultation, and financial and operational support.
Auxiliary medication sites in rural areas, meanwhile, focus on methadone dispensing, telehealth visits, family and individual counseling The benefits to patients of a program like the ROADSS model is that it not only saves time by making it more accessible right in the rural communities, which allows people to fulfill their obligations to their families and continue to work, but it also makes treatment from the central OTP accessible to them through telehealth, which has been proven to work and, in some instances, be as effective as in-person treatment. So they can access an array of treatments like individual sessions, group therapy, family services.
In addition, the ROADSS model provides a level of privacy for them to access the treatment where stigma can be strong in those communities. Methadone maintenance treatment works. It is medication that has been proven for over decades to be the most effective in treating opioid use disorder. It is not substituting one drug for the other.
The ROADSS model is beneficial for providers and organizations in rural communities because it reduces the regulatory burden of trying to establish a new clinic. The central OTP manages and operates the clinical functions of the program. It also makes the comprehensive services from the central OTP accessible to the patients they serve in the rural communities. There is also the opportunity for collaboration between the rural providers and the central OTP specialists when needed.
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Studies have shown medications such as methadone reduce opioid overdose deaths. But one of the challenges in rural areas is that some patients receiving methadone must visit the location of their opioid treatment program (OTP) almost daily. The burden of long-distance travel, which can be costly and disruptive to work and family obligations, can be unmanageable.
ROADSS seeks to ease that burden by helping patients find the resources they need close to their community. The program involves a partnership between an OTP—which may be in an urban location, like Strong Recovery in Rochester, New York—and rural organizations outside of metropolitan areas.
While there are three FDA-approved medications for opioid use disorder (OUD)—buprenorphine, methadone, and naltrexone—the ROADSS program focuses on methadone for a variety of reasons. Historically, methadone maintenance programs have demonstrated wide-ranging benefits for people with OUD and the communities in which they live, such as reducing deaths among people with OUD by approximately 50%, HIV and hepatitis infections, and drug-related crime. Patients in methadone programs have shown improvement in social functioning and tend to stay in rehabilitation programs longer.2 Research also indicates methadone is effective and safe during pregnancy.3
In the ROADSS model, the OTP serves as a central location offering a range of services, including individual and group counseling, prescribing, and methadone dispensing. Auxiliary sites in rural areas, meanwhile, focus on dispensing. Since dosing is more frequent than other aspects of methadone maintenance treatment, these auxiliary sites allow patients in rural communities to receive their medication without having to travel to a distant OTP. In a sense, they expand the dispensing room of the central OTP. The auxiliary sites utilize telehealth to consult with the central OTP and to facilitate patients’ access to other services at the clinic. By using telehealth for individual and family counseling, for instance, the auxiliary sites can further reduce travel demands for patients in rural communities. In addition, auxiliary sites in the ROADSS program are equipped with broadband internet that patients have the option to use.
The ROADSS model takes a regional approach that addresses the specific challenges of methadone delivery. It provides financial and operational guidance to organizations, helps them navigate federal and state regulations, and provides resources to apply in achieving community support.
References
[1] Mack, K. A., Jones, C. M., & Ballesteros, M. F. (2017). Illicit drug use, illicit drug use disorders, and drug overdose deaths in metropolitan and nonmetropolitan areas—United States. American Journal of Transplantation, 17(12), 3241-3252.
[2] Schuckit, M. A. (2016). Treatment of opioid-use disorders. New England Journal of Medicine, 375(4), 357-368.
[3] National Academies of Sciences, Engineering, and Medicine. (2019). Medications for opioid use disorder save lives. National Academies Press, p. 70.