Rural Opioid Prevention and Treatment Strategies: The Experience in Four States

BACKGROUND Although opioid use rates are comparable in rural and urban counties, rural opioid users tend to be younger, unmarried, have lower incomes, and are more likely to lack health insurance, all vulnerabilities that may negatively impact their ability to seek treatment and recover.1 Little is known about what states with large rural populations are doing to combat opioid use disorders (OUDs) in rural communities. In addition to the multiple socio-economic vulnerabilites of rural residents, the rural healthcare system is characterized by numerous resource, workforce, access, and geographic challenges that complicate the delivery of specialized care for OUDs in rural communities. The nature of the opioid crisis varies across rural communities and requires multifaceted, communitybased strategies to address the problem. Based on interviews with key stakeholders in four states, this qualitative study identifies rural challenges to the provision of OUD prevention, treatment, and recovery services, and explores promising state and community strategies to tackle the opioid crisis in rural communities. METHODS Key informant interviews were conducted in Indiana, North Carolina, Vermont, and Washington State, with the overall objective of identifying strategies states and communities are taking to address OUDs in rural areas, and the challenges they face in doing so. A multi-disciplinary advisory panel was convened that included substance use experts from federal agencies, state government, and policy centers. With the panel’s input, the study team selected the four states based on two main criteria: (1) evidence of significant rural opioid problems, and (2) a history of recent and ongoing significant initiatives or actions that included rural community interventions. PB-63-2 April 2017