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Commentary: We Can Reverse the Trend of Worsening Rural Health Care 

Commentary: We Can Reverse the Trend of Worsening Rural Health Care 


If you live in a rural area in America, your life expectancy is lower than if you live in a city. This is an awful truth, and that disparity has only widened in recent years. A study by the USDA’s Economic Research Service found Americans aged 24-54 in rural areas are dying of unintentional causes at a dramatically higher rate than their counterparts in urban areas.

Contributing to this trend is a lack of access to reliable primary, emergency, and specialized healthcare options. The difference between urban and rural health care is especially stark when for rural Americans suffering from opioid use disorder (OUD).

Opioid treatment programs (OTPs) are critical to helping people suffering from OUD. Nationally, there’s already a shortage of these programs, but in rural areas, it’s even worse: 88.6% of rural counties lack adequate OTPs.

Without OTPs, rural communities do not have access to the most effective defense against fentanyl: methadone. Methadone is the most effective medication at preventing fatal fentanyl overdoses, and methadone is only available at OTPs.

For Americans battling a substance use disorder in a rural area, navigating the barriers to accessing high-quality, evidence-based treatment can feel like moving mountains. Studies estimate that the average drive time for people living in rural areas to their nearest OTP is six times greater than for those living in urban areas—a mere 12 minutes for those living in urban settings versus 61 minutes for rural communities. This isn’t simply an inconvenience; it’s a matter of life or death for many.

There’s a simple solution to the struggle that rural Americans face when it comes to dealing with OUD: make treatment as accessible as possible. OUD burdens an already strained rural healthcare system, where 119 rural hospitals have closed in the past 10 years. Recent efforts to build on telehealth services and support local treatment clinics are steps towards a solution—but they’re not enough. Until we’ve significantly improved rural healthcare access, health outcomes will suffer.

Access to healthcare and the ability to live a long and healthy life is a right that rural communities are entitled to just as much as their urban counterparts. By taking deliberate and intentional measures to increase treatment access, we can begin to address the jarringly disparate rate of unintentional death that rural Americans face.

But that’s not all. To effectively address the overdose crisis, we need to also address the underlying reasons why individuals with OUD are more likely to receive suboptimal health care. Research shows that stronger cultural stigma and negative attitudes towards addiction and mental health issues are more prevalent in rural areas.

In small, tight-knit communities, this stigma can create a reluctance to seek help, as individuals fear judgment, social ostracization, or professional repercussions. Such attitudes often discourage individuals from seeking timely treatment for OUD. The fact is, though, that anyone—your neighbors, your friends, and even your family—can struggle with OUD.

The stigma against OUD needs to change nationwide, but rural communities can be the ones driving that change. They know the power of helping their neighbors. With a change in mindset, they can dismantle the stigma around OUD and encourage accessible, reliable treatment for anyone who needs it.

Rural healthcare is getting worse, not better, compared to urban areas—but this trend isn’t set in stone. It’s not inevitable. By expanding access to treatment in rural areas and tackling the stigma associated with seeking help, we can ensure that every American, regardless of zip code, receives the healthcare they deserve.


Libby Jones is the program director of the Overdose Prevention Initiative, a program of the Global Health Advocacy Incubator. The Overdose Prevention Initiative advocates to ensure evidence-based treatment and harm reduction services that help save lives are within reach by advancing federal policies that address the disparities, inequities, and stigma in the addiction treatment system.

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