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Rural Policy

Exploring Barriers to Substance Use Treatment among Adults of Fair or Poor Health in Metropolitan and Nonmetropolitan Counties using West Virginia MATCH Data Maneesha Muriki*, Maneesha Muriki, Zheng Dai,

West Virginia (WV) had the nation’s highest drug overdose death rate in 2023 (81.9 per 100,000). Some drug overdose deaths are preventable with access to treatment. However, nearly 30% of West Virginians live in areas of low or medium-low access to health care, and few studies have examined barriers to alcohol or drug use treatment or counseling (substance use treatment) in WV. This study compared the prevalence of substance use treatment barriers among adults living in metropolitan (metro) and nonmetropolitan (nonmetro) counties. Secondary data analysis used Mountain State Assessment of Trends in Community Health (MATCH) statewide survey data from 2021-2022 (2021) and 2023-2024 (2023), and USDA’s Rural-Urban Continuum Codes for metro and nonmetro county classification. Data represents about 1.4 million weighted population both years. In 2021 and 2023, fair or poor health was more prevalent among adults in nonmetro counties (~28%) than metro counties (~22%). Among all adults with fair or poor health, 29.2% (2021) and 24.5% (2023) reported that they did not receive needed substance use treatment in the past year. In 2021, significantly more adults in nonmetro counties reported insurance coverage (23.1% vs 4.5%) or cost (35.9% vs 20.9%) as barriers to substance use treatment than adults in metro counties. In 2023, significantly more adults in nonmetro counties did not know where to get treatment (62.0% vs 13.0%) or when they did, had no transportation (67.3% vs 20.5%) or harder time finding programs with openings (49.6% vs 21.2%). Whereas more adults in metro counties worried about others finding out (49.2% vs 27.0%) or reported that they were not ready to stop using (43.7% vs 25.3%) compared to adults in nonmetro counties. These results suggest a shift in the type of barriers over time and by setting: structural or resource barriers in nonmetro counties and personal barriers in metro counties. Tailoring efforts to local contexts can strengthen intervention programs.