In America, 15 out of 100 people live in a rural area.  I loved growing up in a rural community, where there were actually no stop lights, everyone knew their neighbors, and doors were always open. But, my years of working in public health has taught me rural areas are not that different from urban areas when it comes to the devastating impact of the opioid epidemic.

The rate of drug overdose deaths in rural areas has surpassed rates in urban areas, and it is a huge public health concern. Understanding how rural areas are different when it comes to drug use and drug overdose deaths, including opioids, can help public health professionals identify, monitor, and prioritize their response to this epidemic.

One Epidemic – Three Waves

Drug overdoses in the United States have now surpassed other leading causes of death like AIDS or motor vehicle crashes, even when they were at their peak.

The opioid overdose epidemic has come in three waves:

1. Increases in deaths involving prescription opioids starting in 1999
2. Increases in heroin-involved deaths starting in 2010
3. Since 2013, we have seen more deaths involving synthetic opioids like illicitly manufactured fentanyl.

CDC is tracking how these waves of overdose deaths are affecting rural versus urban areas of the country to help states and public health departments identify, monitor, and prioritize customized prevention responses.

Rural Communities at Risk

Death rates for unintentional injuries like drug overdoses, falls, and motor vehicle crashes are around 50% higher in rural areas than in urban areas. In general, people who live in rural areas of the United States tend to be older, poorer, and sicker than those living in urban areas. Differences in socio-economic factors, health behaviors, and access to health care services contribute to these differences. From 1999 to 2015, the opioid death rates in rural areas have quadrupled among those 18-25 years old and tripled for females.

Preventing Overdose Deaths in Rural America

Overdose deaths can be prevented through improved public health programs. We can start addressing the opioid overdose epidemic and save lives by:

• Understanding the differences in burden and context of drug use, drug use disorders, and fatal overdose, and identifying how to tailor prevention efforts to local situations between rural and urban areas.
• Teaching healthcare providers about safer opioid prescribing practices and how to treat patients with opioid use disorder (addiction).
• Considering non-opioid pain treatment options, like exercise and physical therapy, cognitive behavioral therapy, or more effective pain medicines (like acetaminophen, ibuprofen, and naproxen). Some of these options may actually work better and have fewer risks and side effects than opioids.
• Supporting training and access to naloxone, a medication that can quickly stop an opioid overdose, for high-risk individuals, families, emergency responders, and law enforcement.
• Increasing access to treatment for opioid use disorder (addiction) through medication-assisted treatment or comprehensive services to reduce infections from injection drug use, like HIV or Hepatitis C.
• Working with public safety to share data, scale up evidence-based strategies, and decrease the illicit drug supply.

The landscape of drug overdoses in America is changing and affects everyone, no matter where they live. As the epidemic continues to evolve and change, we must understand the circumstances that contribute to opioid deaths and remain vigilant to prevent overdoses in our communities. The more we understand about this drug epidemic, the better prepared we all will be to stop it in its tracks and save lives.

Learn more

• Opioid Overdose
  • Information for Providers
  • Information for Patients
• Video: Rx Awareness Stories
• Rural Health
• Vital Signs – Opioid Prescribing
• Rural MMWR – Illicit Drug Use, Illicit Drug Use Disorders, and Drug Overdose Deaths in Metropolitan and Nonmetropolitan Areas — United States