- by Kaitlyn Dickinson
An overdose alert was issued yesterday stating that several suspected opioid overdoses have occurred in our region over the last few days. According to the Owen Sound Overdose Prevention Society, deaths related to an unregulated supply of drugs increased 56% in Grey-Bruce in 2020. More people died from the unregulated supply of drugs in 2020 in our region than from Covid-19. Our friends, family, neighbours and loved ones are dying at an alarming rate, and our community is far behind in efforts to prevent these tragedies.
Due to the challenges of researching health disparities in rural areas, little analysis has been done regarding substance use and barriers to treatment in rural communities. Enough evidence exists nonetheless, to indicate that geographic, social, and economic challenges faced by people living in rural areas like Owen Sound negatively affect harm reduction and treatment options.
Geographic obstacles in rural communities have considerable impact on access to healthcare facilities, peer support groups, treatment services and professionals. The necessity of travelling for treatment presents a unique challenge, as multiple transportation related barriers exist for those living in rural communities. The existence of few outpatient centres, dispersed across less populated areas, necessitates travel over longer distances for those seeking treatment. Rural residents have little to no public transportation options and often must own a vehicle to travel, which presents additional financial barriers such as fuel costs, insurance, and vehicle maintenance. The time commitment is also lengthened for those seeking treatment at facilities in far away locations and driving infractions due to substance use are often a catalyst of treatment, meaning that many people seeking treatment, are unable to drive themselves. The time commitment to commute to and from treatment centres for one person alone can be a hindrance, and so adding another person to the commute as a driver only increases an already existing obstacle.
Harm reduction and treatment of substance use disorders are dependent on continuing care, which is difficult for those who must travel to receive it. Adequate after care sometimes requires assistance from family members and relatives who may be more accessible in rural communities, but family members may also be unable to travel the distance necessary to assist with treatment at far away facilities, and family support alone is not sufficient for most effective therapies. Peer support meetings also take place less frequently than those in urban centres and are more likely to deal with alcohol abuse than other substances. Support groups in rural settings are less diverse and do not offer supports in the same way that city locations are able to provide to people belonging to specific groups based on race, culture, gender, and sexual identity.
There are few mental health services in rural communities, and those that exist are often inadequate. People living in these areas are more likely to experience deteriorating mental health which exacerbates the probability of instances of harmful substance use. Having access to mental healthcare professionals does not always guarantee successful treatment, and professionals in rural communities may be limited to social workers, who are often overwhelmed. Lack of other forms of medical care in rural communities affects access to overlapping services that are integral to effective substance use treatment.
While geographic barriers present significant challenges to those seeking treatment, local attitudes toward substance use in rural communities affect decisions as to whether treatment is sought at all. Stigma plays a significant role in rural attitudes related to substance use and treatment. People who engage in substance use often fear the consequences of strained relationships within their community if their treatment becomes known. Rural residents facing stigma may feel more morally isolated or be criminally policed due to substance use and therefore those in need of treatment are less likely to seek support.
Local attitudes toward substance use and harm reduction are often dismissive, uninformed, and regressive in rural communities. People who use drugs are negatively labelled as “junkies,” and "addicts,” and categorized as lazy, unkempt, or untrustworthy. Professionals with whom much of the rural population interacts frequently hold negative views of morality toward people who use drugs, and substance users are regularly stigmatized by law enforcement.
Harm reduction in rural areas is frequently viewed as enabling and a waste of valuable tax dollars that would be better spent on medical issues not perceived to be related to the poor choices of individuals. According to Bolinski et al. (2021), most respondents in a series of interviews conducted in rural southern Illinois, characterized their communities as, “largely unaware or dismissive of the bio-medical and sociocultural explanations for opioid use, drug injection and toward harm reduction services (e.g., syringe exchanges) and naloxone, which were frequently framed as undeserved usages of taxpayer funds” (p. 1). Looking at the comment section under articles related to overdoses and drug use in Owen Sound, it isn’t difficult to see that similar attitudes exist and are prevalent within our own community. This is disheartening, considering that how communities choose to spend limited government funds is often dependent on local attitudes. In relation to substance use, the distribution of funds may be framed around the assumption that addiction is a choice. Fewer available resources in rural communities lead to more frequent and repeated engagement in harmful substance use. Fewer outpatient centers, with less staff than their urban counterparts, treat a variety of mental health disorders and admission to halfway houses, inpatient programs and continuing care are less available in rural communities.
High poverty and unemployment are known to increase incidents of harmful substance use. In rural areas, reduced employment opportunities have been linked to nonmedical opioid use and drug injection. Economic stresses in rural communities also affect local healthcare systems, which tend to be fragmented. Structural problems contribute to both unemployment and underemployment. The structural issue of remoteness in rural communities hinders economic development, leading to economies that are predominantly comprised of resource-based industries. Those employed in such industries are subject to high rates of workplace injury, disability, and chronic pain, due to a higher density of physically demanding jobs, leading to higher rates of substance use.
The geographic, social, and economic barriers faced by rural communities like Owen Sound present many obstacles to those seeking treatment for substance use. These barriers not only affect access and willingness to seek treatment, but also increase the rate of subsequent use, escalating the risk of harm. Further analysis and intervention are needed to address the adversity of substance use in rural communities. Due to the unique circumstances influencing harmful substance use in rural areas, it is imperative that barriers particular to rural regions are distinguished and diminished so that effective treatments and harm reduction programs may be implemented.
Our community needs to focus on reliable access to services and harm reduction programs, including a safe injection site, in order to regulate a safe supply of drugs. These measures have proven to be effective and lifesaving and should be implemented, regardless of controversial local attitudes.
For more information related to local overdose and peer support, please follow the Owen Sound Overdose Prevention Society on social media.
References:
Berg, M. T., Hochstetler, A. L., Monnat, S. M., & Peters, D. J. (2020). The opioid hydra: Understanding overdose mortality epidemics and syndemics across the Rural‐ Urban continuum. Rural Sociology, 85(3), 589-622. doi:10.1111/ruso.12307
Bolinski, R., Ezell, J., Friedman, S.R., Jenkins, W.D., Link, B., Pho, M.T., et al. (2021). Stigmatize the use, not the user? Attitudes on opioid use, drug injection, treatment and overdose prevention in rural communities. Social Science & Medicine, 268, 113470. doi:10.1016/j.socscimed.2020.113470
Duffy, A., & Mandell, N. (2014) Poverty in Canada. In R. J. Brym (Eds.), Society in question (7th ed., pp. 109-131). Toronto: Nelson Education
Grant, K.M., Tyler, K.A., & Young, L.B. (2015). Community-level barriers to recovery for substance dependent rural residents. Journal of Social Work Practice in the Addictions, 15(3), 307-326. doi:10.1080/1533256X.2015.1056058
Kendall, R., Linden, R., & Lothian Murray, J. (2017). Sociology in our times: Seventh Canadian edition. Toronto: Nelson Education
Owen Sound Overdose Prevention Society: https://www.facebook.com/owensoundops
