EXPLORING INDIVIDUAL EXPERIENCES OBTAINING MEDICATION-ASSISTED TREATMENT FOR OPIOID USE DISORDER IN RURAL NEW MEXICO

In the United States, more than 2.5 million people struggle with opioid use disorder. Compared to people living in urban areas, rural residents are twice as likely to overdose from opioid misuse. Reasons for this increase include excessive opioid prescribing and illegal diversion of opioids. This holds true in the rural counties of northern New Mexico, where drug overdose deaths are among the highest in the nation. Although medication-assisted treatment (MAT) with buprenorphine, methadone, or naltrexone is globally accepted as the most effective treatment, it is still accessed half as often rurally. The reasons for this imbalance are unknown, and there is no information about how the perspectives and knowledge of rural individuals seeking MAT might contribute. To identify key drivers of this imbalance, a descriptive qualitative design was used (a) to explore the perspectives and knowledge of individuals in rural New Mexico with opioid use disorder regarding medication-assisted treatment and (b) to describe their experiences seeking MAT. Six major themes emerged from the data. As participants became addicted, “The chase” for opioids encompassed a set of lifestyle choices aimed at avoiding the sickness and pain of opioid withdrawal. Participants described several challenges in obtaining MAT that made it “hard to have to wait,” including long wait lists, ultimately leading to drug diversion for the purpose of self-medicating. Overwhelmingly, participants favored buprenorphine over heroin and buprenorphine over methadone, with the general themes emerging that suboxone was “better” because it helped them to live a “normal life.” Finally, participants discussed the importance of working with a knowledgeable provider, accessing self-help groups, and building a support system for “staying clean.” Despite treatment successes with MAT, participants continued to experience stigma in the community, establishing the theme that “no matter what, you’re labeled.” In conclusion, although key system-level barriers have been identified and addressed, the rural-urban disparity in access to MAT persists. Results from this study contribute to our knowledge about opioid use disorder (OUD) and its treatment in rural communities. These findings reveal the important factors contributing to the rural-urban MAT disparity, leading to clinical and policy implications that could serve to address this problem

Rural, Cultural & Global Health: As Seen Through the Eyes of Doctoral Students at the University of New Mexico

When our early UNM College of Nursing PhD students wrote Volumes 1-3 of this compilation a decade ago, our program was new and growing, and most of the students lived here in New Mexico or in neighboring states. Much has changed since the initial volumes emerged from our course entitled Rural and Cultural Health (Nursing 611), a graduate elective. The world has embraced enormous linkages through technology. Refugee and migration patterns the world over have more people displaced and seeking a permanent home than ever before. International, national, regional and local contexts, conflicts, politics, health-related policies, economic struggles, racial/ethnic diversity, other kinds of human diversity, and all dimensions of health care have undergone tremendous change and continue to do so at a rapid pace. Students from our own and other universities now take this course online and contribute their insights and experience. Nursing 611 has evolved into an 8-week summer elective offered in even-numbered years, focused on three components of health care: global health, cultural health, and rural health. The students, who represent diversity in heritage, geographic location, and clinical/research interests, were asked to produce 3 briefs, or short papers (each 3-4 pages long), on the three components (global, cultural, and rural health). They were encouraged to write in an engaging style, even resembling the tone of a Ted Talk, to interest readers. This collection represents their focused writing in the three areas. We believe that the state of New Mexico holds unique cultures, characteristics, and problems, yet the health disparities, inequities, population trends, migration patterns, and general state of rural/cultural health the world over are more similar than different. Whatever your own disciplinary connections, we invite you to explore the critical issues presented in the following collection of short essays. In this class, we have defined both culture and rurality broadly and in multiple contexts. Much remains to be done, both locally and globally, to improve the health status of our varied populations and communities. Please join us in the analysis and resolution of the health challenges, inequities, and unresolved needs that characterize many rural and cultural settings.https://digitalrepository.unm.edu/rural-cultural-health/1005/thumbnail.jp

Overcoming Barriers: Individual Experiences Obtaining Medication-Assisted Treatment for Opioid Use Disorder

Medication-assisted treatment (MAT) for opioid use disorder (OUD) is accessed half as often in rural versus urban areas in the United States. To better understand this disparity, we used a qualitative descriptive approach to explore the experiences of individuals with OUD seeking MAT in rural New Mexico. Guided interviews were conducted with 20 participants. The frameworks of critical social theory, intersectionality theory, and the brain opioid theory of social attachment were used to guide data analysis and interpretation. Thematic content analysis derived five major themes which identified novel barriers and facilitators to MAT success, including a perceived gender disparity in obtaining MAT, challenges in building a recovery-oriented support system, and the importance of navigating a new normal social identity. This deeper knowledge of the experiences and perspectives of rural individuals with OUD could serve to address the rural–urban MAT disparity, leading to enhanced recovery capacity and transformative policies

Ending the Chase: Experiences of Rural Individuals with Opioid Use Disorder

Background: The US remains in the midst of an opioid overdose epidemic. Given that rural populations have higher rates of opioid-related morbidity and mortality, it is important to understand the factors that perpetuate opioid use and facilitate recovery in rural communities. Purpose: To explore experiences of individuals living with opioid use disorder (OUD) and to analyze these experiences within a broader sociocultural context. Methods: Using a descriptive, qualitative design, we interviewed twenty purposefully sampled participants. We used thematic content analysis to identify themes and patterns. Results: As participants became dependent, the chase for opioids was to avoid the pain of withdrawal. Waking up sick became an everyday experience, leading to a lifestyle of hustling. The pursuit of opioids resulted in physical, social, emotional, and legal consequences that fed a cycle of stigmatization. In recovery, participants learned to embrace a new way of thinking, allowing them to make new choices. The strong influence of family and community in their lives was a key factor in their resiliency and opioid use experiences. Conclusions: Individuals with OUD are impacted by intersecting social, physical, economic and policy factors that reinforce the expansion of the opioid epidemic rurally. This study provided a voice to rural individuals with opioid use disorder, a group often underrepresented in the literature, providing an understanding of their struggles and the unique sociocultural dynamics that exist in rural northern New Mexico. The complex sociocultural relationships to family and community represent important adaptive factors that could support individual healing and community transformation