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Opioid Misuse in Rural America

The United States is experiencing an epidemic of drug overdose deaths. In 2016, nearly 64,000 Americans died from a drug overdose. At 174 people each day, this is more than the number of lives lost in car accidents or gun-related homicides. An overwhelming majority of these overdose deaths involved an opioid. While no corner of the country has gone untouched by this issue, the opioid epidemic has hit rural America particularly hard.

In October 2017, the Centers for Disease Control and Prevention announced that the rates of drug overdose deaths are rising in rural areas, surpassing rates in urban areas. A November 2017 report from the USDA Economic Research Service revealed rising mortality rates among working age adults living in rural America, stemming in part from prescription drug and heroin misuse. Lastly, a December 2017 survey by the National Farmers Union and the American Farm Bureau Federation found that as many as 74 percent of farmers have been directly impacted by the opioid crisis.

USDA is approaching the opioid crisis with a dedicated urgency. The opioid epidemic is devastating to its victims and their families. It has a compounding ripple effect throughout communities, affecting quality of life, economic opportunity, and rural prosperity. No corner of our country has gone untouched by the opioid crisis, but the impact of this issue on small towns and rural places has been particularly significant. Rates of drug-related deaths in rural areas has surpassed those in urban centers. We are partnering with rural leaders to combat this crisis.

Through leadership provided by Secretary of Agriculture Sonny Perdue and Assistant to the Secretary for Rural Development Anne Hazlett, USDA is investing in prevention, treatment, and recovery capacity at the rural community level through several core programs. Three Rural Development programs offering loans and grants are currently available to assist communities in need.


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Number and age-adjusted rates of drug overdose deaths by state, US 2016

“The opioid epidemic is a pivotal challenge for many rural places. More than a health concern, the opioid crisis is an issue of rural prosperity and will take the commitment, collaboration and creativity of a wide range of partners to address."

- Anne Hazlett, USDA Assistant to the Secretary for Rural Development

USDA Engagement

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Under the leadership of Secretary Perdue and Assistant to the Secretary for Rural Development Anne Hazlett, USDA is investing in prevention, treatment, and recovery capacity at the community level through several core programs. Beyond program investment, Secretary Perdue has created a Rural Development Innovation Center. The Innovation Center is working collaboratively to promote strategic partnerships and local capacity building, identify and share best practices, evaluate data, and streamline regulations to remove barriers to rural prosperity, including access to mental and behavioral health care.

In this activity, Rural Development seeks to support local communities in building resiliency through capacity and infrastructure development, such as transitional housing to assist individuals recovering from addiction.

New USDA Funding Available to Support Projects that Address Opioid Misuse in Rural Communities

On April 4, 2018, Assistant to the Secretary for Rural Development Anne Hazlett announced that USDA is giving funding priority in two key grant programs to address opioid misuse in rural communities. In addition to the resources shown here, our outreach webinar held on April 23, 2018 provides an overview of how Rural Development is prioritizing investments.

  • Community Facilities Program Grants: USDA reserved $5 million in grants for innovative projects that address the opioid crisis in rural America. Rural communities, nonprofit organizations, and federally recognized tribes can apply for up to $150,000 in grants for innovative projects, such as mobile treatment clinics. The grants can be used to fund up to 75 percent of a project’s cost. Application Deadline: June 4, 2018
  • Distance Learning and Telemedicine Grants: USDA will give priority to applications for projects to provide opioid misuse prevention, treatment, or recovery services. Congress has set aside $20 million for Distance Learning and Telemedicine grants specifically for opioid prevention, treatment and recovery projects. Eligible proposals can receive 10 priority points. Application Deadline: June 4, 2018
  • Rural Health and Safety Education Competitive Grants Program (RHSE): These grants are for projects that develop or implement individual and family health education programs to help rural communities address significant health issues. Education programs specializing in prevention and reduction of opioid abuse in rural communities are given priority for funding. For information on how to apply, visit the RHSE 2018 Grant Applicant Webinar presentation (PDF, 1.4 MB). Application Deadline: May 24, 2018

What’s Working?


North Carolina State University, North Carolina

Prevention is a key element in ultimately ending the opioid crisis in the United States. North Carolina State University (NCSU) is stepping up to the challenge to prevent opioid misuse in rural communities in North Carolina. Through a grant from USDA’s National Institute of Food and Agriculture, the NC 4-H Empowering Youth and Families Program together with the NC Office of Rural Health, are working to empower families and communities in Lenior, Montgomery, and Yancey counties. Families with youth ages 10-14 meet weekly to participate in educational sessions that provide age-appropriate research- and evidence-based training in the art of family building and the impact of opioid misuse. They are given the opportunity to practice their new skills and behaviors. The families will also participate in a Family Weekend Confluence bringing youth and their caregivers together for a weekend of action planning and leadership development. Youth and families will be charged with delivering a community opiate prevention campaign within their respective counties. NCSU anticipates reaching 900 individuals through this comprehensive effort.

For more information contact:

Anne Greenaway
EYFP Coordinator
Extension Associate
North Carolina 4-H
NC State University, College of Agriculture and Life Sciences
520 Brickhaven Drive
Raleigh, NC 27695-7606
Campus Box 7655


Connections Withdrawal Management Center, Harrington, Delaware

A partnership between USDA and a rural health organization has resulted in an essential facility that provides a regional response to Delaware’s opioid crisis.

Connections leased a vacant space in Harrington, Delaware’s town center in 2015 and transformed it into a medically monitored, clinically managed withdrawal management/induction center facility for patients withdrawing from opioids, alcohol, benzodiazepines and other similar substances. Connections takes a chronic-care approach to treating substance use disorder, with an emphasis on using the ‘gold standard’ approach to opioid use disorder—medication assisted treatment (MAT). The facility provides on-demand access to MAT, intensive outpatient therapy, linkages and warm handoffs to other treatment resources, and post-withdrawal support services. A USDA Community Facilities loan in 2016 helped Connections cut its monthly expenses in half to purchase the space and expand service offerings.

At first, nearby residents were concerned about public safety issues that might come with having a treatment facility in their neighborhood. But, as the second largest employer in Harrington, the center is a vital part of the community. Local police utilize Connections’ treatment-first approach, saving the department costly trips to facilities outside the area. Furthermore, Connections will add primary care and dental services for local residents when renovations are complete, cementing its place as a key health care provider in the Harrington community and Delaware’s two southern counties, where health care resources are scarce.


Horizon Health Care, Inc., South Dakota

Outside of prescriptions, South Dakota’s Opioid Abuse Advisory Committee has identified that poverty, limited access to mental health services, and inadequate insurance coverage are associated with opioid addiction. In a state where over 40 percent of the population lives in rural areas where these risk factors are prevalent, health centers are faced with the challenge of providing comprehensive care in these high-need communities. With a rural network that covers over one-third of the state and a Sliding Fee Program that ensures affordability, Horizon Health Care, Inc. is uniquely positioned to prevent and treat rural opioid misuse.

For nearly 40 years, Horizon’s growing number of health centers have been delivering medical, dental, and mental health care services to people living in rural, medically underserved communities. At the heart of Horizon’s robust network is its telemedicine program, which originally facilitated psychiatric care. In response to the rising demand for mental health specialists, Horizon has been adding advanced practice providers to the network.

Within the last two decades, Horizon has relied on USDA’s Distance Learning and Telemedicine grants.


Policy & Additional Information

White House

United States Department of Agriculture

United States Department of Health and Human Services

United States Department of Justice


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