Substance Abuse in Rural Communities

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substance abuse in rural communities

Over the past 15 years, statistics have shown an alarming trend in drug-related deaths in the United States; unfortunately, those living in rural areas have been devastated by the rise of overdoses with their numbers soaring higher than those seen in urban or suburban areas. This is especially concerning as statistics regularly show that access to resources and treatments is significantly lower in rural areas when compared to other regions. To fight back against this growing opioid crisis, there needs to be a greater focus on bringing substance use recovery services to rural communities.

Addiction in Rural Areas

Rural is defined as areas that are far away from urbanized cities, often characterized by low population density and limited access to resources. These regions are generally sparsely populated, with a higher percentage of people spread more widely apart than in cities or suburban areas. Most rural populations live in the countryside, small towns, or villages, with few businesses and services.

Rural areas typically have a higher poverty rate than urban and suburban regions, leading to an increased risk for substance use.  This is compounded by the lack of access to healthcare, a lack of mental health treatment and drug abuse prevention services, and the inability to afford addiction treatment. Sadly, these disparities mean that rural communities are more likely to suffer from substance use issues than their urban peers.

Accessibility of Substance Use Recovery Services in Rural Communities

Barriers to access to substance use recovery services in rural communities are multifaceted and can be divided into three main categories: economic, geographical, and social.

Economic Barriers

Rural communities often lack access to the necessary financial resources needed to provide and maintain substance use recovery services. Financial constraints limit the availability of qualified personnel, technology, and materials necessary to provide quality care. Due to the small size of rural populations, there may be a limited number of employers willing to pay wages that are competitive with those offered in larger cities or metropolitan areas.

Geographical Barriers

Rural communities are often geographically isolated, making it difficult for individuals to access services that may be available in larger cities or metropolitan areas. A lack of public transportation options and long distances to travel can make access to recovery services challenging and costly for those without their own transportation.

Social Barriers

The stigma associated with substance use disorder can be a major barrier to individuals seeking help in rural communities. Individuals may feel more comfortable accessing services from a larger city or metropolitan area due to the greater anonymity and fewer people knowing their story. There is often a limited number of providers knowledgeable about behavioral health services and resources in rural communities, making it difficult for individuals to access the help they need.

Legislation Affecting Substance Use Recovery in Rural Communities

In an effort to better support and strengthen rural communities across the United States, various states have implemented laws aimed at addressing substance use disorder in rural areas. These laws range from providing additional funding for treatment programs to increasing access to medications that can help with recovery.

Rural Opioid Abuse Prevention Act (S. 2796)

On December 6, 2022, the House passed the Rural Opioid Abuse Prevention Act (S. 2796) in a bipartisan effort to support rural communities struggling with opioid abuse. This bill provides much-needed funding for community-based responses to this epidemic. It allows grant money to be used specifically for developing pilot programs to reduce opioid overdose deaths. These alternative sentencing programs may enable individuals struggling with substance abuse in rural areas to receive treatment instead of incarceration and equip law enforcement officers and first responders with tools and information to confront drug use and related crimes effectively.

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American Rescue Plan (ARPA)

The American Rescue Plan Act of 2021 (ARPA) was signed into law on March 11, 2021, and provides several provisions aimed at improving access to substance use disorder treatment in rural communities. This includes expanding telehealth services through the Rural Health Clinic Program and investing $1 billion in Substance Abuse and Mental Health Services Administration (SAMHSA) grants to support recovery programs. The ARPA also provides states with a $200 million dollar State Opioid Response Program to help rural areas respond to the opioid epidemic and reduce overdose deaths.

SUPPORT for Patients and Communities Act of 2018

The SUPPORT for Patients and Communities Act of 2018 was signed into law on October 24, 2018. This comprehensive legislation included provisions to reduce opioid abuse in rural communities by increasing access to medication-assisted treatment (MAT), expanding access to naloxone, and authorizing funding for the Comprehensive Addiction and Recovery Act programs. The act also established grants targeted to rural areas to support innovative treatment strategies and help rural communities with substance use disorder. The SUPPORT for Patients and Communities Act also provided resources to enhance access to care in opioid treatment programs, including dedicated funds for telemedicine services that can be used in rural areas.

Comprehensive Addiction and Recovery Act of 2016

On July 22, 2016, the Comprehensive Addiction and Recovery Act (CARA) was enacted to provide resources to help individuals struggling with opioid use disorder. With a focus on prevention, treatment, and recovery services for those affected by this epidemic in rural areas, CARA established grants for organizations providing support for those recovering from substance abuse. It also created the State Targeted Response to the Opioid Crisis program, which provides additional funding to states for the prevention and treatment of opioid use disorder in rural areas. In addition to providing resources, CARA also authorized emergency overdose response grants so those first responders can be equipped with naloxone, an antidote that can reverse opioid overdoses.

By implementing these initiatives, Congress has taken a step in the right direction toward addressing substance use disorder. Though more work is still needed, these laws have provided much-needed support and resources to rural communities facing opioid abuse.

Solutions and Strategies for Making Services More Accessible

Providers can take several steps to be more accessible to the population affected by the opioid epidemic in rural areas:


First and foremost, providers should be aware of the unique challenges those living in rural communities face. Providers must understand how geographic isolation and limited access to healthcare services can limit treatment options for individuals struggling with substance use disorder. Additionally, providers must be aware of the economic and cultural factors that can affect care in rural communities, such as racial disparities and limited resources.


Providers can also ensure that their services are accessible by providing telemedicine services and taking advantage of technology to reach remote areas. Telemedicine is becoming increasingly important in providing care to those in rural areas, as it eliminates barriers such as distance and transportation. It also provides an alternative option for treatment when there is no access to traditional healthcare services. Additionally, providers can create partnerships with other organizations in the community and increase public awareness about the availability of care through outreach programs.


Finally, providers must strive to create a welcoming and inclusive environment that is sensitive to the needs of individuals in rural areas. By understanding the unique challenges faced by those living in rural communities, providers can help ensure that their services are accessible and effective for all individuals struggling with substance use disorder.


The opioid epidemic has had a devastating impact on rural communities across the United States. The laws implemented by Congress have provided much-needed support to those affected by this crisis in rural areas. However, more work must be done to ensure that services are accessible to all individuals struggling with addiction. Providers must be aware of the unique challenges faced by those living in rural areas and take steps to create an environment that is inclusive and sensitive to the needs of individuals. Through the thoughtful implementation of telemedicine services, partnerships with local organizations, and outreach programs, providers can help ensure that treatment is available to all who need it.

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