• Khary K Rigg, Shannon M Monnat, and Melody N Chavez.
• Department of Mental Health Law & Policy, Louis de la Parte Florida Mental Health Institute, College of Behavioral & Community Sciences, University of South Florida, 13301 Bruce B. Downs Blvd., Tampa, FL, 33612, United States. Electronic address: rigg@usf.edu.
• Int. J. Drug Policy. 2018 Jul 1; 57: 119-129.

AbstractOver the last two decades, opioid-related mortality rates have increased dramatically to become a serious public health concern in the United States. Opioid-related mortality has reached epidemic levels in certain rural areas of the U.S., such as Appalachia, New England, and the Mountain West, while remaining relatively low in others, such as the Delta South and Great Plains. Explanations for geographic variation in opioid mortality are unclear, contributing to ineffective policies and interventions. The goal of this article is to summarize the existing literature on the opioid epidemic in the rural U.S. to help guide intervention efforts. This paper 1) describes geographic heterogeneity in opioid-related mortality, with a focus on rural areas, 2) summarizes factors that likely contribute to this heterogeneity, and 3) discusses potential strategies for addressing the opioid epidemic in the hardest-hit rural communities. The information presented in this paper dispels the myth that the opioid epidemic is disproportionately rural, and demonstrates that the magnitude of the epidemic has varied considerably across different rural areas. This paper provides important insights for public health professionals, treatment practitioners, researchers, and policymakers as they work toward solutions that take into account the diversity of rural communities and the dynamic nature of the opioid epidemic.Copyright © 2018 Elsevier B.V. All rights reserved.

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