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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. In addition, 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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Tell us what actions your rural community is taking in prevention, treatment and recovery.

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USDA is a strong partner to communities in addressing the opioid epidemic on two fronts:

Through program resources for prevention, treatment, and recovery opportunities for those in need. See the many ways your community can partner with USDA (PDF, 528 KB) to meet immediate needs in this fight.

Through program resources to help rural communities address many of the deeper, systemic, and long-term issues making these places vulnerable to the opioid crisis in the first place. Our infographic illustrates (PDF, 4.8 MB) how USDA can help rural communities respond to the opioid epidemic by addressing some of the root causes.

USDA Opioid Resource Map

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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.

  • Access & Mobility Partnership Grants: FTA’s Access and Mobility Partnership Grants focus on transportation solutions to medical appointments and other non-emergency healthcare services. The grants will help improve options for people with limited transportation choices and bridge the gap between service providers in the transportation and health sectors. The program supports the work of the inter-agency Coordinating Council on Access and Mobility (CCAM), which works to coordinate federal programs to improve access to jobs, schools, healthcare, and other opportunities. Federal Register Notice (PDF, 213 KB) (Deadline: November 13, 2018, 11:59pm EDT)
  • Federal Office of Rural Health Policy Call For Reviewers: The Health Resources and Services Administration (HRSA) relies on grant reviewers to select the best programs from competitive groups of applicants. Over the coming months, the Federal Office of Rural Health Policy (FORHP) will be competing a number of programs, including the Rural Communities Opioid Response Program-Planning, and will need more reviewers than usual, particularly those with expertise in rural and mental/behavioral health. Reviews are typically held remotely over a period of a few days and reviewers who participate and complete their assigned duties will receive an honorarium. Learn more and register to become a potential reviewer. (Registration is easy and does not commit you to serving as a reviewer.) Please consider lending your expertise to these important initiatives.
  • The Impact of the Opioid Epidemic on Children and Youth in Rural Communities: The 2018 Rural Behavioral Health Webinar Series seeks to provide information and resources, on innovative approaches to address the needs and challenges of rural community behavioral health. These approaches are embedded in a public health framework that acknowledges the role that social, economic, and geographic elements play in the lives of individuals and how it impacts behavioral health and well-being, especially for those in rural settings.

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.


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

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