Substance Use and Misuse in Rural Areas – Resources
Selected recent or important resources focusing on Substance Use and Misuse in Rural Areas.
Examining Geographic Disparities in Access to No-Cost Naloxone in North Carolina: A Cross-Sectional Survey of Naloxone Distribution Programs
Presents a study exploring the geographic distribution of no-cost naloxone in North Carolina. Bases findings on a survey of naloxone distributors in the state and breaks down data by user demographics and distributor type.
Author(s): Grace Marley, Caroline Shubel, Carolyn T. Thorpe, et al.
Citation: Journal of Rural Health, 41(3), e70069
Date: 08/2025
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Presents a study exploring the geographic distribution of no-cost naloxone in North Carolina. Bases findings on a survey of naloxone distributors in the state and breaks down data by user demographics and distributor type.
Author(s): Grace Marley, Caroline Shubel, Carolyn T. Thorpe, et al.
Citation: Journal of Rural Health, 41(3), e70069
Date: 08/2025
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Illegally Made Fentanyl Use in the United States: 2022 and 2023
Report highlights findings from the 2022 and 2023 National Survey on Drug Use and Health (NSDUH) on the use of illegally made fentanyl across the U.S. Explores co-usage with other drugs, emergency room visits/hospitalizations, and breaks down user characteristics by age, poverty level, and rurality, among other measures.
Citation: NSDUH Data Brief, 2(2)
Date: 07/2025
Sponsoring organizations: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration
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Report highlights findings from the 2022 and 2023 National Survey on Drug Use and Health (NSDUH) on the use of illegally made fentanyl across the U.S. Explores co-usage with other drugs, emergency room visits/hospitalizations, and breaks down user characteristics by age, poverty level, and rurality, among other measures.
Citation: NSDUH Data Brief, 2(2)
Date: 07/2025
Sponsoring organizations: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration
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A Comparison of Classifications for Geographic Location and their Associations with Tobacco Use among US Adults
Details a study on the differences in two different rural classification in rates of cigarette, e-cigarette, and smokeless tobacco usage. Compares U.S. Census Bureau's definition of urban and rural areas with the National Center for Education Statistics' urban/suburban/town/rural classification.
Author(s): Jenny E. Ozga, Andrea Milstred, Melissa D. Blank, et al.
Citation: Journal of Rural Health, 41(3), e70070
Date: 06/2025
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Details a study on the differences in two different rural classification in rates of cigarette, e-cigarette, and smokeless tobacco usage. Compares U.S. Census Bureau's definition of urban and rural areas with the National Center for Education Statistics' urban/suburban/town/rural classification.
Author(s): Jenny E. Ozga, Andrea Milstred, Melissa D. Blank, et al.
Citation: Journal of Rural Health, 41(3), e70070
Date: 06/2025
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Evaluation of the Maternal Opioid Misuse (MOM) Model: Fourth Annual Report (Implementation Year 3)
Provides an overview of the Maternal Opioid Misuse Model, which provides evidence-based integrated care and care coordination for pregnant and postpartum Medicaid beneficiaries with opioid use disorder (OUD). Describes activities MOM Model awardees undertook during the MOM Model's second implementation year, July 1, 2023–June 30, 2024, and summarizes qualitative and beneficiary-level process data findings by state awardee. Discusses barriers pregnant and postpartum women with OUD face in accessing high-quality, continuous care, specifically in rural areas.
Additional links: Findings at a Glance
Date: 06/2025
Sponsoring organizations: Centers for Medicare and Medicaid Services, Westat
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Provides an overview of the Maternal Opioid Misuse Model, which provides evidence-based integrated care and care coordination for pregnant and postpartum Medicaid beneficiaries with opioid use disorder (OUD). Describes activities MOM Model awardees undertook during the MOM Model's second implementation year, July 1, 2023–June 30, 2024, and summarizes qualitative and beneficiary-level process data findings by state awardee. Discusses barriers pregnant and postpartum women with OUD face in accessing high-quality, continuous care, specifically in rural areas.
Additional links: Findings at a Glance
Date: 06/2025
Sponsoring organizations: Centers for Medicare and Medicaid Services, Westat
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Effects of Using Different Rural Measurements on Estimates of Hospitalizations for Depression and Substance Use
Explores how using different rural measurements can affect estimates of hospitalization rates for behavioral health conditions. Highlights how rural-urban commuting areas (RUCA) codes, core-based statistical areas (CBSA), urban-rural category four (URCategory4), and rural urban continuum codes (RUCC) affect hospitalization estimates. Discusses the consequences these difference can have on policy.
Author(s): Robin Danek, Justin Blackburn, Marion Greene, et al.
Citation: BMC Health Services Research, 25, 818
Date: 06/2025
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Explores how using different rural measurements can affect estimates of hospitalization rates for behavioral health conditions. Highlights how rural-urban commuting areas (RUCA) codes, core-based statistical areas (CBSA), urban-rural category four (URCategory4), and rural urban continuum codes (RUCC) affect hospitalization estimates. Discusses the consequences these difference can have on policy.
Author(s): Robin Danek, Justin Blackburn, Marion Greene, et al.
Citation: BMC Health Services Research, 25, 818
Date: 06/2025
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Continuity of Pain Clinic Care Among Rural and Urban Veterans
Presents a study exploring the differences in continuity of pain care through the Veterans Health Administration (VHA) for rural and urban veterans. Breaks down data by age, sex, pain severity, and behavioral health disorders, among other measures.
Author(s): Katherine Hadlandsmyth, Rena E. Courtney, Jenna L. Adamowicz, et al.
Citation: Journal of Rural Health, 41(2), e70031
Date: 05/2025
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Presents a study exploring the differences in continuity of pain care through the Veterans Health Administration (VHA) for rural and urban veterans. Breaks down data by age, sex, pain severity, and behavioral health disorders, among other measures.
Author(s): Katherine Hadlandsmyth, Rena E. Courtney, Jenna L. Adamowicz, et al.
Citation: Journal of Rural Health, 41(2), e70031
Date: 05/2025
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Federal and State Reimbursement for Youth Behavioral Health Services
Report details Medicaid and Children's Health Insurance Program (CHIP) coverage of behavioral health services for rural people under 21 years of age. Breaks down reimbursement eligibility for behavioral health providers in all 50 states and discusses barriers to access in rural areas.
Date: 04/2025
Sponsoring organization: WWAMI Rural Health Research Center
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Report details Medicaid and Children's Health Insurance Program (CHIP) coverage of behavioral health services for rural people under 21 years of age. Breaks down reimbursement eligibility for behavioral health providers in all 50 states and discusses barriers to access in rural areas.
Date: 04/2025
Sponsoring organization: WWAMI Rural Health Research Center
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The Rural and Urban Supply of Clinicians With a DEA Waiver to Prescribe Buprenorphine in 2022 Prior to the Elimination of the Waiver Requirement
Report explores the differences in rates of clinicians with DEA waivers to prescribe buprenorphine in 2022 in rural versus urban counties. Highlights the rural gaps in access to buprenorphine to treat opioid use disorder prior to the elimination of the DEA waiver requirement in 2023. Provides rural, urban, and regional comparisons.
Date: 04/2025
Sponsoring organization: WWAMI Rural Health Research Center
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Report explores the differences in rates of clinicians with DEA waivers to prescribe buprenorphine in 2022 in rural versus urban counties. Highlights the rural gaps in access to buprenorphine to treat opioid use disorder prior to the elimination of the DEA waiver requirement in 2023. Provides rural, urban, and regional comparisons.
Date: 04/2025
Sponsoring organization: WWAMI Rural Health Research Center
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Different Forms of Stigma and Rural Primary Care Professionals' Willingness to Prescribe Buprenorphine
Presents a study exploring the different types of stigma affecting buprenorphine and other medications for opioid use disorder (MOUD) prescribing rates in rural primary care settings. Details perceived stigmas around MOUD by providers, such as the fear of being harmed by patients, fear of their professional image being harmed, and the fear of the medications harming their patients.
Author(s): Berkeley Franz, Lindsay Y. Dhanani, Sean Bogart, et al.
Citation: Journal of Substance Use & Addiction Treatment, 171, 209633
Date: 04/2025
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Presents a study exploring the different types of stigma affecting buprenorphine and other medications for opioid use disorder (MOUD) prescribing rates in rural primary care settings. Details perceived stigmas around MOUD by providers, such as the fear of being harmed by patients, fear of their professional image being harmed, and the fear of the medications harming their patients.
Author(s): Berkeley Franz, Lindsay Y. Dhanani, Sean Bogart, et al.
Citation: Journal of Substance Use & Addiction Treatment, 171, 209633
Date: 04/2025
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"I'm Tired of Seeing My Friends Die": Barriers and Facilitators to Participating in Clinical Trials Among Rural People Who Use Drugs in the United States
Highlights a study exploring the barriers and facilitators to clinical trial participation by rural people who use drugs (PWUDs). Bases findings on interviews with rural PWUDs in Kentucky, Ohio, and Oregon.
Author(s): Kathryn E. Lancaster, Angela T. Estadt, Madison N. Enderle, et al.
Citation: Journal of Rural Health, 41(1), e70009
Date: 03/2025
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Highlights a study exploring the barriers and facilitators to clinical trial participation by rural people who use drugs (PWUDs). Bases findings on interviews with rural PWUDs in Kentucky, Ohio, and Oregon.
Author(s): Kathryn E. Lancaster, Angela T. Estadt, Madison N. Enderle, et al.
Citation: Journal of Rural Health, 41(1), e70009
Date: 03/2025
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Additional resources are available related to this guide. See the full list of resources by topic for:
- Alcohol use
- Behavioral health
- Behavioral health workforce
- Illicit drug use
- Prescription drug misuse
- Substance use and misuse
- Tobacco use
Last Updated: 9/30/2025