Need for Substance Use Disorder Programs in Rural Communities

In 2014, substance use disorder (SUD) treatment admissions data showed that the most common substances abused in rural areas were alcohol, marijuana, stimulants, opiates, and cocaine. According to data from the 2021 National Survey on Drug Use and Health, treatment for alcohol and illicit drug use was slightly higher among people aged 12 or older living in nonmetropolitan counties compared to metropolitan counties. This section will provide an overview of key issues related to SUDs in rural areas.

Alcohol Use Disorders in Rural Communities

The 2021 National Survey on Drug Use and Health (NSDUH) found that past-month heavy alcohol use was higher in rural counties compared to urban counties for those 18 and older. In addition, past-month binge alcohol use was higher in rural counties than urban counties among 18-25 year olds. A 2012 brief from the Maine Rural Health Research Center suggested several factors unique to rural areas that could contribute to disparities in youth binge drinking, including:

Less parental disapproval for underage alcohol use
Greater acceptance of alcohol use among rural adolescent peers
Greater availability of alcohol in wealthier households
Greater access to alcohol provided by adults through family gatherings and purchasing of alcohol for youth

Methamphetamine Use Disorders in Rural Communities

The 2021 NSDUH found that rates of methamphetamine use were twice as high among adults aged 18 and older who live in nonmetro areas compared to their counterparts in large metro areas (1.6% vs. 0.8%). According to the U.S. Department of Justice Drug Enforcement Administration (DEA), domestic methamphetamine production has drastically decreased since the early 2000s, from a peak of 23,703 methamphetamine laboratory incidents in 2004 to only 1,568 in 2018. However, reports indicate that cheaper and purer sources of methamphetamine from outside of the U.S. are contributing to a resurgence of use in rural areas.

Opioid Use Disorders in Rural Communities

The U.S. has seen a dramatic increase in rates of opioid misuse and deaths resulting from opioid overdose. According to the Agency for Healthcare Research and Quality (AHRQ), between 2010 and 2017, the national rate of opioid-related inpatient stays increased by 76.6% in rural locations, from 154.3 per 100,000 population in the first quarter of 2010 to 272.5 per 100,000 population in the last quarter of 2017. Emergency department visits related to opioid misuse increased 95.8% in rural locations from 99.2 per 100,000 population in the first quarter of 2010 to 194.2 per 100,000 population in the last quarter of 2017. AHRQ provides an infographic that compares the rates of opioid-related hospital stays by state.

As with the rest of the country, rural areas have been severely affected by the epidemic. In 2017, rural counties exhibited a higher rate of natural and semisynthetic opioid overdoses than urban counties. Illicitly manufactured synthetic opioids, such as fentanyl and carfentanil, have also led to spikes in opioid overdose and overdose related deaths. Opioid misuse is especially high in states with large rural populations such as West Virginia and Kentucky. Populations with the highest rates of opioid misuse in rural areas include:

Adolescents ages 12-19
Adults ages 20-29
Men
Individuals with less than a high school education
Individuals who are uninsured
Individuals with low incomes

Resources to Learn More

Appalachian Overdose Mapping Tool
Map/Mapping system
Combines social, demographic, and economic data with county drug overdose death rates in a data visualization tool for rural Appalachia. Provides communities with information to identify key areas for discussion, prevention, and intervention.
Organization(s): NORC at the University of Chicago, Appalachian Regional Commission

Drug Overdose Deaths in the United States
Map/Mapping System
Helps leaders, researchers, and policymakers assess effective actions for addressing the opioid crisis at the local level. Overlays substance misuse data against socioeconomic, census, and other public information.
Organization(s): NORC at the University of Chicago, U.S. Department of Agriculture (USDA) Rural Development

Opioid-Related Inpatient Stays and Emergency Department Visits by State, 2009-2014
Document
Provides data on opioid-related inpatient hospital stays and emergency department visits in the U.S. based on 2005-2014 data from Healthcare Cost and Utilization Project (HCUP) Fast Stats.
Author(s): Weiss, A.J., Elixhauser, A., Barrett, M.L., et al.
Organization(s): Agency for Healthcare Research and Quality
Date: 12/2016 (Revised 01/2017)

Opioids' Burden on Hospital Care: A State-by-State Comparison
Document
Map of the U.S. comparing the rates of opioid-related hospital stays by state.
Organization(s): Agency for Healthcare Research and Quality
Date: 12/2016

Rural Opioid Abuse: Prevalence and User Characteristics
Document
Examines the prevalence of opioid users in rural and urban areas, and discusses their common demographic and economic characteristics and how they differ between urban and rural areas.
Author: Lenardson, J., Gale, J., & Ziller, E.
Organization(s): Maine Rural Health Research Center
Date: 2/2016