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In rural areas, prescription opioids contribute to a larger share of drug overdose deaths than either heroin or synthetic opioids (Figure 3). In 2016, prescription opioids were involved in 31 percent of drug overdose deaths in nonmetro counties, compared to 24 percent for synthetic opioids and 16 percent for heroin. In metropolitan counties, synthetic opioids were involved in 32 percent of drug overdose deaths, while heroin and prescription opioids were each involved in 26 percent. In both urban and rural areas, the contribution of prescription opioids to drug overdose deaths Over the last two decades, opioid1 overdose deaths have increased over 400 percent, reaching 45,838 in 2016.2 Although the crisis is not disproportionately worse in rural3 than in urban America, opioid mortality rates have grown faster in rural areas, particularly in the Northeast and Midwest. Rural areas also face unique challenges in dealing with the crisis, including a smaller health care infrastructure than is available in more densely populated areas, community and family factors, and labor market stressors.

The Opioid Crisis in Rural and Small Town America