Urban-Rural Disparities in Opioid Use Disorder Prevention and Response Activities: A Cross-Sectional Analysis.

Purpose: Urban and rural areas have been differentially impacted by opioid use disorder (OUD) and related adverse outcomes, yet little systematic study of the urban-rural divide in OUD prevention and response activities exists. This study compares policy and programmatic activities to tackle the opioid crisis in metropolitan versus nonmetropolitan areas, and within their subclassifications.

Methods: All county governments in 5 purposively selected states were surveyed. Metropolitan and nonmetropolitan counties, and their subclassifications, were compared in their reported implementation of 19 opioid policy and programmatic activities, using 2-sample proportion and 1-way analysis of variance (ANOVA) tests with Bonferroni-corrected multiple comparisons.

Findings: Of the 358 counties surveyed, 171 (response rate = 48%) responses were obtained. The implementation rate of nonmetropolitan counties was lower than that of metropolitan counties for all activities, although not all differences were statistically significant. Within nonmetropolitan areas, the implementation rate of noncore counties was lower than that of micropolitan counties for all activities, and statistically significant differences were found for providing treatment and rehabilitation facilities, allowing arrest alternatives for opioid offenses, and providing opioid detection and treatment training to first responders, among other activities.

Conclusions: The results of this study corroborate claims that nonmetropolitan areas, and particularly noncore areas, face greater barriers to implementing opioid policy and programmatic activities. This study identifies activity areas where rural counties are especially lacking and federal and state governments could support efforts for bending the curve of the opioid crisis.