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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.

The impact of this epidemic on small towns and rural places is painfully visible.  From the coast of Maine to the hills of southeast Ohio, opioid misuse has created lost productivity in jobs, increased health care demands, and put great stress on emergency response, law enforcement, judicial and school system resources.  The opioid crisis has also put a significant strain on families where millions of children are being raised by grandparents or extended family because of addiction.  Finally, beyond community resources and family stability, the opioid epidemic is impacting rural prosperity.  For many rural counties already operating on slim budgets and struggling to attract new businesses or maintain existing employers, the consequences of this issue for rural communities are very real. 

As rural leaders respond to this growing challenge, an effective solution to addressing this issue will take leadership and collaboration from a broad range of partners at the federal, state and local level.  Under the leadership of Secretary of Agriculture Sonny Perdue, USDA is keenly focused on facilitating prosperity in rural America.  With a concern for quality of life and economic opportunity, USDA is partnering to strengthen local responses to the opioid epidemic in rural communities. 

The purpose of this website is to assist rural leaders with resources, information and best practices to help rural communities respond to and manage the crisis.

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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

Under the leadership of Secretary Perdue and Anne Hazlett, Assistant to the Secretary for Rural Development, 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 transition housing to assist individuals recovering from addiction.  

Three USDA programs that can assist rural communities combating the opioid epidemic include: 

The Community Facilities Loan and Grant Program (CF): These loans and grants can be used to build, renovate, equip, or rehabilitate essential community facilities such as hospitals, mental health clinics, withdrawal centers, educational facilities, and more. To learn more about this program, contact your local state USDA Rural Development office.

The Distance Learning & Telemedicine Grants Program (DLT): These grants can be used to purchase and install equipment that uses broadband to help rural communities remotely connect to educational and health care services. Telemedicine can help rural health care facilities access and provide specialized treatment for patients in need. To learn more about this program, contact USDA Distance Learning and Telemedicine Program staff at

The Rural Health and Safety Education Competitive Grants Program (RHSE):  These grants are for projects that develop or implement individual and family health education programs that 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. To learn more about this program, visit the National Institute of Food and Agriculture website.

Beyond USDA, Secretary Perdue chaired an interagency task force on Agriculture and Rural Prosperity which was created by President Donald J. Trump in 2017.  In January 2018, the Task Force released a series of recommendations (PDF, 5.4 MB) to increase rural prosperity and improve quality of life in rural America, including a recommendation to modernize healthcare access.  The Task Force found that improved access to mental and behavioral health care, particularly prevention, treatment, and recovery resources, is vital to addressing the opioid crisis and other substance misuse in rural communities.

Best Practices


Avita Health System, Ontario, Ohio

In the early 2000s, shopping malls were often a symbol of growth and prosperity in rural America, but, in recent years, however, many of these rural establishments have declined. Avita Health System in Ontario, Ohio, had an innovative approach to revive such an unused retail space.

With affordable financing from USDA’s Community Facilities Direct Loan program, Avita Health System was able to transform a vacant section of a shopping mall into a state-of-the-art hospital that provides health care services including substance use disorder treatment and mental health services essential for rural Ohio communities that have been affected by the opioid epidemic in recent years.

The hospital opened in March 2017 and serves more than 125,000 rural residents in three Ohio counties. Knowing they play a leading role in response and recovery, Avita Health System is working with local community leaders to create an actionable strategy to address this challenge and fill the gap in accessible treatment for rural people.


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.


North Lakes Community Clinic, Ashland, Wisconsin

According to Wisconsin’s Department of Health Services, 827 people died in the state from opioid overdoses in 2016. From 2000 to 2016, the number of deaths due to prescription opioids increased 600 percent.  North Lakes Community Clinic has responded to the crisis with a unique public-private partnership.

North Lakes serves 10 counties and, with USDA’s help, is expanding their opiate treatment program. In 2015, North Lakes received funding from the State of Wisconsin to start a Heroin and Opiate Prevention and Education (H.O.P.E.) program at their Ashland and Iron River locations. H.O.P.E. staff work with patients seeking treatment for opiate addiction.  Treatment options include medication-assisted treatment combined with alcohol and other drug abuse counseling. The H.O.P.E. Program has been enormously successful. North Lakes has helped more than 500 people in the last two years.

USDA Rural Development provided North Lakes Community Clinic with a $5 million Community Facilities Direct Loan in December 2017 to purchase and renovate a building in downtown Ashland. North Lakes will use the space for its recovery programs to accommodate growing group therapy needs and also house their dental program which will grow from one to three full time dentists. Based on the H.O.P.E. Program’s success,  North Lakes received new state funding to expand their recovery services to include treatment for methamphetamine addiction, and to replicate their program in Douglas County in partnership with Lake Superior CHC, a sister health center.

In Hayward, Wisconsin, Chippewa Valley Bank provided a $1.3 million Community Facilities Guaranteed Loan enabling North Lakes to acquire and remodel a medical clinic to house their recovery and mental health programs. North Lakes is also expanding its recovery program from one day per week to three days per week and adding two new psychotherapists to counsel patients.