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
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
Project Lazarus
Updated/reviewed November 2021
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
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
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
Seneca Strong's Certified Addiction Recovery Coaches
Updated/reviewed July 2022
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.


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.
Project VISION
Updated/reviewed December 2021
Updated/reviewed December 2021
- 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.
Morrison County Accountable Community for Health
Updated/reviewed September 2021
Updated/reviewed September 2021
- 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.

Updated/reviewed August 2021
- 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.

Updated/reviewed December 2020
- 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 5 years of the program, ARMOT received over 1,950 referrals.
Last Updated: 7/18/2022