Substance abuse has become a major health problem in many of America's rural communities. In addition to marijuana, methamphetamine, and cocaine, which have been cited as drugs of abuse in rural areas for several years, the misuse of prescription pain relievers has increased alarmingly in rural and urban areas over the past decade. Despite these increases in drug use, access to substance abuse treatment remains insufficient in many rural communities. The implementation of Medicaid expansion under the ACA could improve access to substance use treatment overall in the U.S., but it is not clear whether and to what extent the ACA Medicaid expansion will improve insurance coverage and access to substance use treatment in rural areas, especially in localities characterized by low levels of income and education. It is critical to understand how Medicaid expansions may impact these vulnerable groups that experience disproportionally high prevalence rates of substance abuse and a sizable unmet need for treatment.

This project's primary objective was to examine the effects of Medicaid expansion on insurance coverage and access to substance abuse treatment across rural to urban areas as well as rural-urban differences in the policy effects. A secondary objective was to examine whether the effects of Medicaid expansion on coverage and access differ between rural areas with low and high socioeconomic status (SES) as well as between low-SES and high-SES rural residents with substance use disorders.

Publications

• Illicit Drug and Opioid Use Disorders Among Non-Metropolitan Residents
  Policy Brief
  Rural and Underserved Health Research Center
  Date: 01/2018
  We provide estimates of the prevalence of illicit drug and opioid use disorders among non-metropolitan adults ages 18-64. Prevalence rates did not decline from 2011-2013 to 2014-2015 despite the implementation of major substance use treatment policies. Of particular concern, heroin use disorder prevalence increased in recent years.
• Perceived Treatment Need and Utilization for Illicit Drug and Opioid Use Disorders in Non-Metropolitan Areas
  Policy Brief
  Rural and Underserved Health Research Center
  Date: 01/2018
  The vast majority of non-metropolitan adults 18-64 who satisfy criteria for an illicit drug use or opioid use disorder do not perceive a need for treatment or receive formal substance use treatment. Despite policies to increase treatment access during the 2008-2015 study period, we found few changes in perceived treatment need and utilization.