Rebecca L. Haffajee, J.D., Ph.D., M.P.H. Assistant Professor Department of Health Management & Policy University of Michigan School of Public Health

Limited Opioid Addiction Treatment Resources Should Be Geared Towards Most Affected Counties Interview with:

Rebecca L. Haffajee, J.D., Ph.D., M.P.H. Assistant Professor Department of Health Management & Policy University of Michigan School of Public Health

Dr. Haffajee

Rebecca L. Haffajee, J.D., Ph.D., M.P.H.
Assistant Professor
Department of Health Management & Policy
umichsphumichsph What is the background for this study? What are the main findings? 

Response: Evidence suggests that the availability of medications to treat opioid use disorder (OUD) has been slow to expand, particularly in rural areas, despite the efficacy and effectiveness of these medications in reducing overdose deaths and other adverse life outcomes. We were interested in understanding the characteristics of counties both with high need (as measured by above-national rates in opioid overdose deaths) AND low provider capacity to deliver medications to treat OUD in 2017.

We found that such “opioid high-risk” counties were likely to be in the East North Central (e.g., Michigan, Ohio, Illinois, Indiana), South Atlantic (e.g., North Carolina, South Carolina, Virginia, West Virginia), and Mountain (e.g., New Mexico, Arizona, Nevada) regions.

We also found that these opioid high-risk counties were more likely to have higher rates of unemployment and less likely to have fewer primary care clinicians or be micropolitan What should readers take away from your report?

Response: Readers, including policymakers, should consider targeting limited opioid addiction treatment resources to specific counties we identified. Other strategies, like increasing employment opportunities and bolstering the primary care workforce capable of treating addiction, also may reduce opioid harms in these counties. What recommendations do you have for future research as a result of this work?

Response: Future research could update our findings with more recent data, given the ever-evolving nature of this opioid crisis. Other research could track the availability of medications to treat OUD over time, rather than at a point in time, to see if changes at the sub-state and state levels seem to reduce overdose risk.
Finally, research could assess whether resources allocated to bolster addiction treatment and social supports, for instance through the SAMHSA Substance Abuse Prevention and Treatment Block grants to states and the SUPPORT for Patients and Communities Act, improve opioid-related outcomes. Is there anything else you would like to add? 

Response: We increasingly understand that the opioid crisis differs by locale and calls for targeted strategies. The shortage of evidence-based addiction treatment for the millions with OUD has been persistent and must change. This study provides new information to assist in identifying opioid high-risk counties and developing strategies to target addiction treatment resources. In particular, finding ways to draw providers into this workforce treating OUD where they are needed and to provide integrated care across settings seems critical to reducing opioid-related harms. 


Haffajee RL, Lin LA, Bohnert ASB, Goldstick JE. Characteristics of US Counties With High Opioid Overdose Mortality and Low Capacity to Deliver Medications for Opioid Use Disorder. JAMA Netw Open. Published online June 28, 20192(6):e196373. doi:10.1001/jamanetworkopen.2019.6373

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Last Updated on June 30, 2019 by Marie Benz MD FAAD