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 October 2022

Need: Increase medical management knowledge for New Mexico primary care providers in order to provide care for the thousands of rural and underserved patients with hepatitis C, a chronic, complex condition that has high personal and public health costs when left untreated.
Intervention: Project leveraging an audiovisual platform to accomplish "moving knowledge, not patients" that used a "knowledge network learning loop" of disease-specific consultants and rural healthcare teams learning from each other and learning by providing direct patient care.
Results: In 18 months, the urban specialist appointment wait list decreased from 8 months to 2 weeks due to Hepatitis C patients receiving care from the project's participating primary care providers. Improved disease outcomes were demonstrated along with cost savings, including those associated with travel. The project model, now known as Project ECHO® – Extension for Community Healthcare Outcomes — has evolved into a telementoring model used world-wide.

Effective Examples

Project Lazarus
Updated/reviewed November 2021

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

Vermont Hub-and-Spoke Model of Care for Opioid Use Disorder
Updated/reviewed August 2020

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 May 2020

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.

Other Project Examples

funded by the Federal Office of Rural Health Policy

MIST: Mothers and Infants Sober Together
Updated/reviewed May 2023

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.

Addiction Recovery Mobile Outreach Team (ARMOT)
Updated/reviewed January 2023

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: Since 2015, ARMOT has received over 2,956 referrals.

funded by the Health Resources Services Administration

ASPIN's Certified Recovery Specialist Program
Updated/reviewed September 2022

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 (CHWs) to be certified health insurance enrollment navigators and provide mental health services.
Results: This year, ASPIN trained 230 CHWs, cross-trained 70 behavioral health case managers as CHWs, and 35 individuals in the Indiana Navigator Pre-certification Education.

Morrison County Accountable Community for Health
Updated/reviewed September 2022

Need: To combat prescription drug misuse in rural Morrison County, Minnesota.
Intervention: The Morrison County ACH brought 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.

Seneca Strong's Certified Addiction Recovery Coaches
Updated/reviewed July 2022

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, with the goal of reducing substance misuse across the Nation.
Results: Seneca Strong has since grown in personnel and capacity to meet the needs of the Allegany and Cattaraugus territories of the Seneca Nation.

Community Connections, Inc. Rural Health Opioid Program
Updated/reviewed December 2021

Need: To reduce deaths due to opioid overdose in rural southeast West Virginia.
Intervention: The Community Connections, Inc. Rural Health Opioid Program trained and certified first responders, healthcare staff, and laypeople in naloxone administration.
Results: From October 2018 to September 2021, the program provided direct education to 638 individuals, trained 821 providers, and distributed 4,023 Narcan kits.

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Last Updated: 5/2/2023