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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 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.
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 2020
  • 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 reduced patients' average morphine equivalent daily dose, and 29% of patients successfully tapered off chronic opioid therapy.

Other Project Examples

funded by the Federal Office of Rural Health Policy Addiction Recovery Mobile Outreach Team (ARMOT)
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.
funded by the Federal Office of Rural Health Policy MaineGeneral Harm Reduction Program
Updated/reviewed December 2020
  • Need: To reduce deaths from opioid overdoses in rural Maine.
  • Intervention: The MaineGeneral Harm Reduction Program provides community education/training for healthcare staff, first responders, community agency staff, and community members in rural Kennebec and Somerset counties.
  • Results: MaineGeneral continues to train providers, provide stigma assessments, and distribute Narcan kits.
Morrison County Accountable Community for Health
Updated/reviewed August 2020
  • 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.
funded by the Federal Office of Rural Health Policy SLV N.E.E.D.: Naloxone Education Empowerment Distribution Program
Updated/reviewed August 2020
  • 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: In addition to continuing to train nearly all first responders to administer naloxone, the organization provides harm reduction education in various community settings.
Litchfield County Opiate Task Force
Added March 2020
  • Need: To reduce substance use and harm from the opioid crisis in rural Litchfield County, Connecticut.
  • Intervention: A community network has come together to improve treatment and develop creative ideas and interventions as a response to the opioid crisis.
  • Results: More than 50 people from various sectors of the community meet each month. The LCOTF has also improved service coordination, access, and cross-sector communication; helped expand the number of agencies offering medication-assisted treatment; and introduced harm reduction resources.

Last Updated: 12/30/2020