Miles from Recovery: How distance and stigma keep rural Arizonans from opioid treatment
AZPM News | by Jake Steinberg | Feb. 6, 2020
Elfrida, Arizona, is a cold and dark place at 3 a.m. in January. But it’s where Anhelica Gonzalez emerges with only a few hours’ sleep to ready her 2-year-old daughter Zarhianna for their journey to Sierra Vista.
Their MedStar ride takes them on mountain roads frequently crossed by deer and cloaked in fog. “Last time we had to wait. We had to sit on the side of the road because we couldn’t even see in front of us,” she said.
An hour later, she arrives at her destination: Community Medical Services. It’s an opioid treatment program where Gonzalez, 36, goes to get her weekly supply of methadone, which she’s using to wean herself off prescription opioid painkillers.
The clinic opened last March — the first in Cochise County to offer medication-assisted treatment. This type of treatment, previously only available in Arizona’s big cities, has expanded into rural communities in the last two years.
Increasing access to medication-assisted treatment is a pillar of the state’s strategy to combat the opioid epidemic, but distance and stigma against addiction still present barriers that keep people from getting help.
Gonzalez was prescribed oxycodone in 2008 to treat the chronic pain that comes with her degenerative disc disease. She built up a tolerance and soon she said her withdrawals made it impossible to quit.
“To feel that pain and to have to feel nauseated and not be able to move and not be able to eat anything, almost worse than the flu, and then having kids, you can’t function like that,” she said. “You can actually die from withdrawing.”
Experts consider medication-assisted treatment the “gold standard” for treating opioid addiction. It's on the World Health Organization's list of essential medicines. Research shows it’s more effective than trying to quit cold turkey. That’s because the proper dose of methadone keeps patients from going through painful withdrawal, but without the euphoric effects of illicit opioids.
Methadone is itself a synthetic opioid and has the potential for abuse. It’s highly regulated. Patients have to go to the clinic every day for up to three months before they can start to take doses home.
That requirement makes treatment in rural areas especially difficult, said Haley Horton, regional director for Community Medical Services in Southern Arizona.
“Until we opened, there was not much,” she said. “I think we would have people driving upwards of four hours a day to receive services.”
Horton has overseen the opening of clinics in Sierra Vista, Casa Grande, Nogales, Kingman and Lake Havasu City — all in the past year.
Initially buoyed by state grants, those clinics are now serving hundreds of new patients, according to data provided by Community Medical Services. Opening a clinic in smaller communities isn’t easy. They’re costly operations with staffing requirements that can’t always be met in the communities they’re entering.
Horton said getting started is a challenge, but the clinics have quickly grown into sustainable operations.
Since 2017, the state has funneled some of the $75 million it has received from the federal government to providers willing to branch out into so-called treatment deserts.
But it’s still hard to reach everybody. An Arizona Public Media analysis identified communities that are still at least an hour's drive from the nearest clinic.