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Rural Response to the Opioid Crisis – Models and Innovations

These stories feature model programs and successful rural projects that can serve as a source of ideas and provide lessons others have learned. Some of the projects or programs may no longer be active. Read about the criteria and evidence-base for programs included.

Evidence-Based Examples

Project ECHO® – Extension for Community Healthcare Outcomes
Updated/reviewed July 2017
  • Need: To increase the capacity for more effective treatment of chronic, complex conditions in rural and underserved communities.
  • Intervention: Through a specially-designed project, remote primary care providers work with academic specialists as a team to manage chronic conditions of rural patients, expanding remote providers' knowledge base through shared case studies.
  • Results: Patient management and care provided by rural providers through ongoing education and mentoring from Project ECHO® has proved as effective as treatment provided by specialists at a university medical center.

Effective Examples

Vermont Hub-and-Spoke Model of Care for Opioid Use Disorder
Updated/reviewed July 2019
  • Need: Increase access to medication-assisted treatment for opioid use disorder in rural Vermont.
  • Intervention: Statewide hub-and-spoke treatment access system.
  • Results: Increased treatment capacity and care coordination.
Midcoast Maine Prescription Opioid Reduction Program
Updated/reviewed April 2019
  • Need: Reduction in the number of emergency department dental patients abusing opioid prescriptions in rural southeastern Maine.
  • Intervention: Using a one-page opioid prescription guideline, opioid prescribing and emergency room visits for dental pain decreased.
  • Results: The rate of opioid prescription dropped nearly 20% after implementation, and in comparing the 12-month period before and after implementation, dental pain emergency department visits decreased from 26 to 21 per 1,000.
Project Lazarus
Updated/reviewed January 2018
  • Need: To reduce overdose-related deaths among prescription opioid users in rural Wilkes County, North Carolina
  • Intervention: Education and tools are provided for prescribers, patients and community members to lessen drug supply and demand, and to reduce harm in prescription opioid use
  • Results: Opioid overdose death rates have decreased in Wilkes County

Promising Examples

Integrated Chronic Pain Treatment and Training Project
Updated/reviewed October 2018
  • Need: To reduce prescription opioid misuse and overdoses in North Carolina.
  • Intervention: The ICPTTP standardizes and streamlines chronic pain management in primary care clinics.
  • Results: The ICPTTP has reduced patients' average morphine equivalent daily dose, and 29% of patients have successfully tapered off chronic opioid therapy.

Other Project Examples

Morrison County Accountable Community for Health
Updated/reviewed August 2019
  • Need: To combat prescription drug misuse in rural Morrison County, Minnesota.
  • Intervention: The Morrison County ACH brings together primary care, social services, law enforcement, and other partners to make sure that patients receive treatment and support.
  • Results: One pharmacy saw a 40% reduction in the number of prescribed opioids, and the ACH was able to taper 684 patients off opioids completely.
Opioid Overdose Prevention Outreach Program
Updated/reviewed August 2019
  • Need: To reduce opioid use disorder and overdose deaths in Maryland's Eastern Shore counties.
  • Intervention: An outreach program educates healthcare providers, EMS staff, and laypeople on the risks of opioids, prevention and treatment options, and Narcan training.
  • Results: Program coordinators have presented information to 988 people in Maryland's Eastern Shore counties and certified 609 people in Narcan training.
funded by the Federal Office of Rural Health Policy ASPIN's Certified Recovery Specialist Program
Updated/reviewed July 2019
  • Need: Improved approach in addressing the behavioral health and primary care disparities of Indiana's underserved rural counties.
  • Intervention: A network was established that trained community health workers (CHW) to be certified health insurance enrollment navigators and provide mental health services.
  • Results: This year, ASPIN trained 61 CHWs, cross-trained 37 behavioral health case managers as CHWs, and 26 individuals in the Indiana Navigator Pre-certification Education.
funded by the Health Resources Services Administration New Horizons Substance Use Recovery Network
Updated/reviewed July 2019
  • Need: In northern Michigan, a need for an integrated approach to deliver medication-assisted treatment for established patients of Federally Qualified Health Centers with opioid use disorder.
  • Intervention: Collaboration between one FQHC across 3 sites, a local waivered prescriber group, and a behavioral health organization created an integrated treatment approach for opioid use disorder.
  • Results: Increased access to medication-assisted treatment and comprehensive substance use disorder services leading to increased retention in treatment and increased engagement in stable recovery from opioid and alcohol use disorders.
funded by the Federal Office of Rural Health Policy funded by the Health Resources Services Administration Project Renew
Updated/reviewed July 2019
  • Need: To reduce deaths due to opioid overdose in rural southeast West Virginia.
  • Intervention: Project Renew trained and certified first responders, healthcare staff, and laypeople in naloxone administration.
  • Results: From April to June 2019, Project Renew has provided direct education to 120 individuals, completed 173 provider education activities, and distributed 260 Narcan kits.
Project VISION
Updated/reviewed July 2019
  • Need: To reduce opioid use and increase quality of life in Rutland, Vermont.
  • Intervention: Project VISION works to reduce opioid use through community engagement.
  • Results: Since 2012, Project VISION has collected and disposed of 550 pounds of unused medications, reduced thefts by over 32%, and had a 50% improvement on a neighborhood quality of life survey.
Seneca Strong's Certified Recovery Peer Advocates
Added June 2019
  • Need: Like many Native American populations, the Seneca Nation of Indians has experienced disproportionate rates of opioid, alcohol, and substance misuse.
  • Intervention: The Seneca Nation Government and Executives founded Seneca Strong, a cultural recovery peer advocate program, to try to reduce substance misuse across the Nation.
  • Results: Since the start of the program, 300 people have received help from recovery peer advocates. Seneca Strong has since extended to meet the needs of Allegany and Cattaraugus territories.
funded by the Federal Office of Rural Health Policy MIST: Mothers and Infants Sober Together
Updated/reviewed May 2019
  • Need: To address the needs of pregnant women who are using substances and infants born into drug-positive families.
  • Intervention: The Mothers and Infants Sober Together (MIST) program assisted mothers who used substances get treatment and provide a safe, drug-free home for themselves and their newborn.
  • Results: MIST has helped mothers find treatment and education and has helped children grow up in safe and healthy homes.
funded by the Federal Office of Rural Health Policy Addiction Recovery Mobile Outreach Team (ARMOT)
Updated/reviewed December 2018
  • Need: To reduce the number of overdoses and overdose-related deaths from opioids in rural Pennsylvania.
  • Intervention: 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.
  • Results: In the first 3 years of the program, ARMOT has received 943 referrals.
funded by the Federal Office of Rural Health Policy Nevada Rural Opioid Overdose Reversal (NROOR)
Updated/reviewed December 2018
  • Need: To reduce the number of overdoses and deaths related to opioid overdose in rural Nevada.
  • Intervention: The Nevada Rural Opioid Overdose Reversal (NROOR) Program, led by a Critical Access Hospital (CAH), furnished naloxone and provided education on prescription opioid use and overdose.
  • Results: In total, 117 EMTs were trained on the administration of naloxone. EMTs greatly appreciated the naloxone training and the naloxone kits.
Foundations Family Medicine's HIV, HCV, Opioid and Substance Use Disorder Services
Added November 2018
  • Need: Due to the opioid crisis, Austin, Indiana has seen the largest concentrated outbreak of HIV in rural America's recent history. Since 2015, over 200 residents have been diagnosed with the virus.
  • Intervention: Foundations Family Medicine began offering testing and treatment services for HIV, hepatitis C, and opioid/substance use disorder. Education, care coordination and behavioral health services were also offered as an integrated part of their primary care clinic.
  • Results: Although the virus continues to spread throughout Scott County, the rate has significantly decreased, outdoing national suppression rates by a large margin (76% compared to national average of 49%).
funded by the Federal Office of Rural Health Policy MaineGeneral Harm Reduction Program
Updated/reviewed August 2018
  • Need: To reduce deaths from opioid overdoses in rural Maine.
  • Intervention: The MaineGeneral Harm Reduction Program provides community education and training for healthcare staff and first responders in rural Kennebec and Somerset counties.
  • Results: During the grant period, MaineGeneral trained 45 deputies and 246 healthcare staff and educated 60 community members.
funded by the Federal Office of Rural Health Policy SLV N.E.E.D.: Naloxone Education Empowerment Distribution Program
Updated/reviewed July 2018
  • Need: Growing concern in rural Colorado communities regarding prescription and illegal opioid overdoses.
  • Intervention: Education efforts for health workers and the larger community, in addition to establishing a naloxone overdose reversal drug program.
  • Results: Nearly all first responders are now trained to administer naloxone, participating pharmacies keep adequate naloxone stock, and ongoing service region dialogue to address opioid abuse.
The Dawn Center Intensive Outpatient Program
Updated/reviewed June 2017
  • Need: To treat substance addiction in rural South Carolina avoiding expensive inpatient facilities, including a treatment aim of keeping patients in their home communities.
  • Intervention: The Dawn Center offers an outpatient program for patients with substance abuse and addiction.
  • Results: Patients can receive counseling and treatment closer to home while becoming a part of the local recovery community.

Last Updated: 8/6/2019