In this brief, authors Shannon Monnat and Khary Rigg examine rural versus urban differences in opioid mortality and identify challenges for dealing with the opioid crisis in rural areas. They report that, in 2016, opioid mortality rates were higher in urban than in rural counties, particularly in the Midwest, but rates have increased more in rural than in urban counties over the past two decades. Since 2010, the share of drug overdose deaths involving prescription opioids has declined, but the share of deaths involving heroin and synthetic opioids has spiked in both rural and urban areas. The most dramatic increases in opioid deaths were in the rural Midwest, where they were 16 times higher in 2016 than in 1999, and in the rural Northeast, where they were 11.4 times higher. Prescription opioids are involved in a larger share of rural than urban drug overdose deaths, whereas heroin and synthetic opioids (such as fentanyl) account for a larger share of urban deaths. Over half of drug overdose deaths involve multiple drugs. Policy initiatives to date have been largely ineffective at addressing the opioid crisis in many of the hardest-hit rural communities, and the recent surge in fentanyl overdoes in large urban areas may be a precursor of what to expect in at-risk rural communities in the coming years. Existing interventions are unlikely to be effective without addressing the underlying social and economic factors that are plaguing the hardest-hit areas.

Publication Date

Summer 6-19-2018


National Issue Brief No. 135


Durham, N.H. : Carsey School of Public Policy, University of New Hampshire

Document Type



Copyright 2018. Carsey School of Public Policy. These materials may be used for the purposes of research, teaching, and private study. For all other uses, contact the copyright holder.





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