Rural Response to the Opioid Crisis

Prevalence of Opioid Prescribing, Diagnoses of Opioid Use Disorder, Treatment Patterns, and Costs Among Rural Medicare Beneficiaries, FORHP-funded study by the Maine Rural Health Research Center

Opioid Use and Treatment Availability – Rural Health Research Recap summarizing findings from FORHP-funded rural health research center studies.

University of Minnesota Rural Health Research Center

• Non-Medical Opioid Use Among Rural and Urban Pregnant Women, 2007-2014, 8/2018
• Practical Implications: Opioid-Affected Births to Rural Residents, 9/2018

Rural and Underserved Health Research Center

• Risky Substance Use Behaviors Among Adolescents Residing in Nonmetropolitan and Metropolitan Counties in the United States, 2017-2018, 11/2020
• Risky Substance Use Behaviors Among Adults Residing in Nonmetropolitan and Metropolitan Counties in the United States, 2017-2018, 11/2020
• Illicit Drug and Opioid Use Disorders among Non-Metropolitan Residents, 1/2018

Maine Rural Health Research Center

• Opioid-Related Visits to Rural Emergency Departments, 2/2021
• Substance Use among Rural and Urban Youth and Young Adults, 11/2020
• Rural Opioid Abuse Prevention and Treatment Strategies: The Experience in Four States, 4/2017
• Rural Opioid Abuse: Prevalence and User Characteristics, 2/2016

Opioid Use and Treatment Availability – Rural Health Research Recap summarizing findings from FORHP-funded rural health research center studies.

Opioid-Related Hospital Use – National data on inpatient stays and emergency department visits by level of rurality. To access rural data, select the Trend Graph or Trend Table view and select Patient location under Characteristics.

MMWR Opioid Reports – Lists reports in the Morbidity and Mortality Weekly Report focused on opioid misuse. Many of these reports include data on rural opioid use.

Drug Overdose Deaths in the United States – Interactive map identifying drug overdose deaths by county, along with related sociodemographic and economic information.

Data Sources and Data-Linking Strategies to Support Research to Address the Opioid Crisis – Identifies data sources available to conduct research on the opioid crisis and describes methods for linking or merging these data sources.

Toolkit: Using Data Analysis To Calculate Opioid Levels and Identify Patients At Risk of Misuse or Overdose – HHS Office of the Inspector General guide for using prescription drug claims data to analyze patients' opioid levels and identify those at risk of opioid misuse or overdose.

Rural Communities in Crisis: A Critical Count to Save Lives During the Opioid Epidemic – A toolkit and calculation tool rural communities can use to estimate the size and characteristics of the population who inject drugs, in order to estimate service needs.

See the Resources section of this guide for many additional reports and other resources describing the rural opioid crisis.

Prevention Programs for Youth and Families

Community Coalitions Prevention Models

Prevention Policies

Preventing Substance Misuse in Rural Settings – A guide to delivering substance misuse prevention programming in rural communities. Identifies challenges and strategies specific to rural areas.

Combatting the Opioid Epidemic Through Rural Coalitions – Presentation slide deck that highlights prevention activities and events rural coalitions can offer.

Using Evidence-Based Stigma Elimination Techniques – Presentation slide deck providing guidance on how to address stigma.

Prescription Drug Monitoring Programs

Proper Drug Disposal Programs

Midcoast Maine Prescription Opioid Reduction Program (Effective)
In two midcoast Maine emergency departments, an easy-to-follow, one page protocol was implemented to assist providers in treating patients complaining about pain and also patients presenting opioid or controlled substance abuse behavior.

Medicare Part D Opioid Prescribing Mapping Tool – An interactive tool from CMS that shows opioid prescribing at the state, county, and zip code level.

Department of Veterans Affairs Opioid Prescribing Data – A map showing VA facility opioid-dispensing rates.

U.S. Opioid Dispensing Rate Maps – County-level prescription dispensing rate maps from the CDC.

Pain Management Best Practices Inter-Agency Task Force: Updates, Gaps, Inconsistencies and Recommendations — Final Report – Identifies clinical best practices for managing chronic and acute pain.

Indian Health Service: Pain Management – Resources to help address the challenges providers face helping patients with chronic pain while preventing illegal or harmful use of opioids.

Rx Awareness – A CDC campaign to increase awareness of the danger of prescription opioids.

Six Building Blocks: A Team-Based Approach to Improving Opioid Management in Primary Care – Provides a structured approach for improving management of patients on chronic opioid therapy. Offers a self-assessment and implementation guide.

Quality Improvement and Care Coordination: Implementing the CDC Guideline for Prescribing Opioids for Chronic Pain – A guide to help primary care providers, practices, and healthcare systems manage patients who are on long-term opioid therapy.

SLV N.E.E.D.: Naloxone Education Empowerment Distribution Program
The San Luis Valley Area Health Education Center has initiated opioid-related education efforts for health workers and the larger community in addition to establishing a naloxone distribution program.

Rural Variation in Access to Naloxone for Opioid Overdose Prevention, FORHP-funded study by the Rural and Underserved Health Research Center

SAMHSA Opioid Overdose Prevention Toolkit – Guidance for community members, first responders, prescribers, patients, and families in responding to an overdose, including information on administering naloxone.

HRSA Poison Help Line – Connect to your local poison control center for free advice from medical professionals. 1-800-222-1222

Nine grant awards co-funded by the CDC, National Institute on Drug Abuse (NIDA), the Appalachian Regional Commission (ARC), and the Substance Abuse and Mental Health Services Administration (SAMHSA) to help communities prevent and treat consequences of opioid injection.

Trends and Predictors of Human Immunodeficiency Virus (HIV) in Light of the Opioid Crisis Along the Urban-Rural Continuum, FORHP-funded study by the Southwest Rural Health Research Center

Tackling the Trifecta: State Approaches to Addressing Co-Occurring Substance Use Disorders, HIV, and Hepatitis C – National Academy for State Health Policy report on innovative approaches to address co-morbidities. Includes rural perspectives.

Opportunities to Improve Opioid Use Disorder and Infectious Disease Services: Integrating Responses to a Dual Epidemic – Report from the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine focused on integrating infectious disease and opioid use disorder services.

Integrating Responses at the Intersection of Opioid Use Disorder and Infectious Disease Epidemics – Proceedings from a workshop focused on the link between the opioid crisis and infectious disease such as HIV and HCV. Includes rural information. The workshop presentations are also available.

Infectious Diseases and Opioid Use Disorder (OUD) Policy Issues and Recommendations – A report that highlights policy considerations, including those focused on rural settings, for addressing infectious disease linked to injection drug use.

The Intersection of Hepatitis, HIV, and the Opioid Crisis: The Need for a Comprehensive Response – An issue brief from NASTAD (the National Alliance of State and Territorial AIDS Directors) that includes suggested public health actions.

Managing HIV and Hepatitis C Outbreaks Among People Who Inject Drugs: A Guide for State and Local Health Departments – A guide from the CDC, with information on outbreak preparedness and detection, investigation, and response.

A Guide to Establishing Syringe Services Programs in Rural, At-Risk Areas – Provides an overview of syringe services programs and discusses issues specific to rural areas. Includes examples of rural syringe exchange programs.

Determination of Need for Syringe Services Programs – CDC guidance on how states, tribes, and territories can request a determination of need for SSPs, which would allow use of federal funds to support this service.

Threading the Needle – How to Stop the HIV Outbreak in Rural Indiana – A New England Journal of Medicine perspective piece describing steps taken to address an HIV outbreak tied to injection drug use.

Drug Overdose Deaths Involving Cocaine and Psychostimulants with Abuse Potential – United States, 2003–2017 – MMWR (Morbidity and Mortality Weekly Report) article that includes data for metropolitan, micropolitan, and non-core counties.

Nonfatal Drug and Polydrug Overdoses Treated in Emergency Departments — 29 States, 2018–2019 – MMWR (Morbidity and Mortality Weekly Report) article that includes rural/urban data on opioid use in combination with other types of drugs.

Suicide Prevention Resource Center – Federally supported resource center devoted to advancing the implementation of the National Strategy for Suicide Prevention. Includes resources and guidance for developing effective suicide prevention programs.

Treatment of Stimulant Use Disorders – SAMHSA guide that discusses effective practices to treat stimulant use disorders, clinical challenges associated with these disorders, and implementation strategies that can be used to address those challenges.

Project ECHO® — Extension for Community Healthcare Outcomes – Provides rural providers with ongoing education and mentoring from specialists.

Integrating Opioid Use Disorder Treatment Into Health Workforce Training – Recording of a webinar focused on health workforce training related to treating opioid use disorder. Includes case studies from Colorado and Nevada.

Education and Training for Primary Care Providers in Medication Assisted Treatment and Opioid Use Disorder Care – Documents a Twitter chat focused on training for primary care providers to provide medication-assisted treatment.

Substance Use Warmline – Teleconsultation to support primary care providers in managing complex patients with addiction, chronic pain, and behavioral health issues.

Caring for Women with Opioid Use Disorder: A Toolkit for Organization Leaders and Providers – Offers resources to support coordinated care delivery for women with OUD, covering engagement in care, critical partnerships to improve care coordination, and cultural shifts regarding addiction and treatment.

Rural Medication for Opioid Use Disorder (MOUD) Toolkit

Rural Prevention and Treatment of Substance Use Disorders Toolkit – Medication-Assisted Treatment Models

New Horizons Substance Use Recovery Network
Medication-assisted treatment for patients with opioid use disorder in rural Northern Michigan.

MIST: Mothers and Infants Sober Together
Helps mothers who used substances to get treatment, including medication-assisted treatment, and provide safe, drug-free homes for themselves and their newborns.

• Comparing Two Ways to Provide Treatment for Pregnant Women with Opioid Use Disorder
• Comparing Two Methods to Deliver a Health Education Program for Pregnant Women Treated for Opioid Use Disorder in Rural Kentucky -- The PATH Home Trial

Primary Care Medication-Assisted Treatment for Opioid Use Disorder Grantees – An Agency for Healthcare Research and Quality initiative to support rural primary care practices in delivering medication-assisted treatment (MAT).

Characteristics of Buprenorphine Therapy Among Commercially-Insured Pregnant and Postpartum Women, FORHP-funded study by the Rural Health Equity Research Center

Rural and Underserved Health Research Center

• Early-Career and Graduating Physicians More Likely to Prescribe Buprenorphine, 1/2020
• Practice Predictors of Buprenorphine Prescribing by Family Physicians, 1/2020

WWAMI Rural Health Research Center

• Tracking the Geographic Distribution and Growth of Clinicians with a DEA Waiver to Prescribe Buprenorphine to Treat Opioid Use Disorder, Article Abstract, 3/2021
• Prescribing Practices of Nurse Practitioners and Physician Assistants Waivered to Prescribe Buprenorphine and the Barriers They Experience Prescribing Buprenorphine, Article Abstract, 10/2019
• Overcoming Barriers to Prescribing Buprenorphine for the Treatment of Opioid Use Disorder: Recommendations from Rural Physicians, Article Abstract, 10/2018
• Projected Contributions of Nurse Practitioners and Physicians Assistants to Buprenorphine Treatment Services for Opioid Use Disorder in Rural Areas, Article Abstract, 8/2018
• Geographic Distribution of Providers With a DEA Waiver to Prescribe Buprenorphine for the Treatment of Opioid Use Disorder: A 5‐Year Update, Article Abstract, 6/2018
• Prescribing Practices of Rural Physicians Waivered to Prescribe Buprenorphine, 6/2018
• Barriers Rural Physicians Face Prescribing Buprenorphine for Opioid Use Disorder, 7/2017

Implementing Medication-Assisted Treatment for Opioid Use Disorder in Rural Primary Care: Environmental Scan, Volume 1 and Volume 2 (Tools and Resources) – Agency for Healthcare Research and Quality reports that summarize findings from the literature and identify tools to support MAT.

Buprenorphine and the Opioid Crisis: A Primer for Congress – Congressional Research Service report examining the effectiveness of, demand for, and access to buprenorphine.

Location of Medication-Assisted Treatment for Opioid Addiction: In Brief – Congressional Research Service report that discusses the availability of MAT and policy options for rural access to MAT.

Medication-Assisted Treatment (MAT) Training and Mentoring/DATA 2000 Waiver – Free training and mentoring for eligible healthcare providers to obtain a waiver allowing them to deliver MAT. Providers with a DATA 2000 Waiver are priority applicants for some National Health Service Corps loan repayment programs.

Treatment Models

Recovery Models

Vermont Hub-and-Spoke Model of Care for Opioid Use Disorder
A statewide treatment access system using a hub-and-spoke approach to provide access to comprehensive opioid use disorder treatment.

ASPIN Network's Certified Recovery Specialist Program
A Community Health Worker/ Certified Recovery Specialist training program that prepares people who are recovering from substance abuse to provide peer support to others with substance abuse issues.

Addiction Recovery Mobile Outreach Team (ARMOT)
ARMOT provides 1) case management and recovery support services to individuals with substance use disorders and 2) education and support to rural hospital staff, patients, and their loved ones. Read more about ARMOT in the Rural Monitor: Pennsylvania Mobile Team Addresses Substance Use Disorders.

Seneca Strong's Certified Recovery Peer Advocates
A recovery peer advocate program that helps reduce substance misuse among the Seneca Nation community.

Opioid Use Disorder: Challenges and Opportunities in Rural Communities
Identifies federal and state strategies to address treatment capacity, including expanding the workforce authorized to prescribe buprenorphine and using technology to provide treatment. Highlights how Scott County, Indiana responded to an HIV outbreak related to opioid use disorder (OUD) by addressing the barriers to care faced by people with OUD and HIV.

Rural and Underserved Health Research Center

• Perceived Treatment Need and Utilization for Illicit Drug and Opioid Use Disorders in Non-Metropolitan Areas, 1/2018

FindTreatment.gov – A substance abuse treatment locator, searchable by type of treatment offered and other factors.

Become an NHSC Site – Information on eligibility and application instructions for becoming a National Health Service Corps site, which allows facilities to recruit and hire NHSC providers, including those specializing in mental and behavioral health. The NHSC has added new categories of outpatient services and sites eligible for NHSC to address the opioid crisis.

Opioid Epidemic Practical Toolkit: Helping Faith and Community Leaders Bring Hope and Healing to Our Communities – Center for Faith-based and Neighborhood Partnerships toolkit providing practical steps that community and faith-based organizations can take to help address the opioid crisis. The Partnership Center also offers a collection of videos.

The Opioid Use Disorder Prevention Playbook – Identifies 11 evidence-based strategies communities can use to help address the opioid crisis.

Opioid Treatment Programs – Information and resources from CMS related to the Medicare Part B benefit for opioid use disorder (OUD) treatment services.

Best Practices for Recovery Housing – SAMHSA guide that lists 10 guiding principles for providing safe, effective, and legal recovery housing.

Movable: Narratives of Recovery and Place – Shares narratives on recovery from substance and alcohol use disorders in Appalachia and beyond.

Rural Health Care and Medicaid Telehealth Flexibilities, and Guidance Regarding Section 1009 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act (Pub. L. 115-271), entitled Medicaid Substance Use Disorder Treatment via Telehealth – Guidance from CMS on the use of telehealth to provide substance use disorder treatment.

The Special Registration for Telemedicine: In Brief – Congressional Research Service report describing changes to the Controlled Substance Act (CSA) authorizing the use of telemedicine to help address the opioid crisis.

Using Telehealth to Identify and Manage Health and Substance Use Disorder Conditions in Rural Areas – Describes how telehealth supports substance use disorder treatment, with focus on treatment of opioid use disorders in rural areas.

Integrating Telemedicine for Medication Treatment for Opioid Use Disorder in Rural Primary Care: Beyond the COVID Pandemic – Highlights the successes of telehealth expansion during COVID-19 and suggests ways it could be used to increase access to medication treatment for OUD.