Opioid Impact on Rural America

In last week’s blog post, we talked about how hospitals, practices and providers can leverage technology to combat the rising opioid epidemic – which has reached 115 deaths per day. In this post, we will speak specifically to the impact the opioid epidemic is having on rural communities within America.

Rural Opioid Use and Impact

Rural adults tend to think that opioid misuse is more of an urban problem than a rural problem. American Farm Bureau Federation and National Farmers Union sponsored survey tells a different story; nearly half of rural adults report being affected by the crisis and even admit that it is easy to access opioids. In the rural farming community, these rates significantly increase with 75% reporting being affected and ease of access to opioids.

Pain Management

Rural Americans’ jobs tend to be more physically intensive – think agriculture and coal mining. Strenuous physical labor over 15 to 20 years contributes to medical conditions associated with acute and chronic pain. In the 1990s, prescription opioids were marketed to physicians as a safe, non-addictive way to treat pain. Additionally, there was a new medical campaign pushing providers to address and alleviate their patients’ pain.

Since then, the addictive nature of prescription opioids has come to light, and their ability to effectively treat chronic pain long-term is unproven. News headlines in 2016, highlighted the flood of manufacturer opioid shipments to small, rural counties despite rising overdose rates. As prolific “doctor shopping” and cash-based pain clinics operated in rural counties and mom-and-pop pharmacies were filling legal controlled substance prescriptions, prescription opioid addiction and diversion gained a foothold in rural America. Rural providers still face a tough decision when treating pain in their patients as access to physical therapy, an alternative to pain meds, is typically not easily accessible for their patients.

Prenatal Care

While limited studies have been done, JAMA Pediatrics did find from 2004 to 2013, infants born with drug-dependencies increased sevenfold in rural areas. Urban areas increased as well, but at nearly half the rural rate. With opioid misuse on the rise, the lack of prenatal opioid treatment and physician experience in rural areas is alarming. Mother and child’s health are at risk and a generational cycle is put in motion.

Some providers are taking it upon themselves to help combat this epidemic. One notable physician in California’s Shasta County helps train and mentor other primary care physicians in the area of opioid addiction and pregnancy. Patients in her county have no other local treatment or care options.

Addiction Treatment

In rural America, the ratio of people per licensed drug and alcohol counselor is more than three times less than urban areas. In addition to the lack of addiction treatment options, treatment options can be cost prohibitive and accessibility can be near impossible with a lack of public transportation. Additionally, the stigma surrounding opioid addiction plays a role in rural patients not seeking treatment.

The Role of Technology

On a positive note, telehealth is well-positioned to be a tool to help those in rural areas needing addiction treatment. Federally, HHSA and SAMHSA provide funding to rural health organizations and community health centers to aid in substance abuse disorder treatment and recovery.

Where to start: Get EPCS Enabled

EPCS, which is the secure, electronic transmission of a controlled substance prescription direct to a pharmacy, and PDMP, which are state programs that collect prescription data with the intention of allowing prescribers to review a patient’s medication history prior to prescribing, will contribute to combatting the rural opioid crisis. If your clinic is not already leveraging this technology, contact Azalea Health for an EHR demo including EPCS to see how an EHR built for rural practices can benefit you and your patients.



  1. https://surescripts.com/enhance-prescribing/e-prescribing/e-prescribing-for-controlled-substances/
  2. https://www.fb.org/issues/other/rural-opioid-epidemic/
  3. http://thehealthcareblog.com/blog/2018/09/25/remember-that-oath-epcs-and-the-fight-against-opioid-abuse/
  4. https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates
  5. https://www.chcf.org/blog/rural-pregnant-women-with-opioid-addiction-find-a-doctor-not-a-judge/
  6. https://jamanetwork.com/journals/jamapediatrics/article-abstract/2592302
  7. http://www.namsdl.org/library/Frequency%20of%20PMP%20Data%20Reporting%20Map%201-2-18%20(Update)/
  8. http://www.namsdl.org/library/CAE654BF-BBEA-211E-694C755E16C2DD21/
  9. https://www.washingtonpost.com/national/health-science/states-require-doctors-to-use-prescription-drug-monitoring-systems-for-patients/2018/01/12/c76807b8-f009-11e7-97bf-bba379b809ab_story.html
  10. https://www.addictioncenter.com/community/substance-abuse-mental-illness-and-access-to-care-in-rural-america/
  11. https://www.wvgazettemail.com/news/cops_and_courts/drug-firms-poured-m-painkillers-into-wv-amid-rise-of/article_99026dad-8ed5-5075-90fa-adb906a36214.html
  12. https://www.maratp.org/rural-vs-urban.html
  13. https://www.vox.com/2017/6/5/15111936/opioid-crisis-pain-west-virginia