Illicit Drug and Opioid Use Disorders Among Non-Metropolitan Residents


Our objectives were to provide up-to-date and nationally representative estimates of illicit drug use disorders by investigating: 1) Non-metropolitan and metropolitan differences in past year prevalence rates of any illicit drug, opioid, heroin, and prescription pain reliever use disorders among adults ages 18-64, and 2) Temporal changes in past year prevalence rates of illicit drug use disorders amongst metropolitan and non-metropolitan adults ages 18-64.

We conducted analyses of nationally representative data from the National Survey on Drug Use and Health for the years 2008-2015. Metropolitan and non-metropolitan status was defined according to U.S. Office of Management and Budget definitions. Analyses were restricted to persons who satisfied DSM-IV criteria for a drug use disorder in the same survey year. We examined the presence of any past year drug use disorder as well as the prevalence of any past year opioid disorder, a past year heroin use disorder, and a past year prescription pain reliever use disorder. We conducted descriptive and bivariate analyses to compare and contrast prevalence rates for drug use disorders across metropolitan and non-metropolitan areas and time periods. Next, we conducted logistic regression analyses to test for metropolitan vs. non-metropolitan differences in the odds of drug use disorders after adjusting for 1) demographics characteristics only and 2) demographic, social, and economic characteristics.

Very few differences in prevalence rates were found between metropolitan and non-metropolitan residents, providing further evidence that drug use disorders are no longer a strictly urban phenomenon. Of particular concern are increases in heroin use disorders among non-metropolitan adults in recent years. Moreover, we found that the prevalence of drug use disorders did not decline among non-metropolitan and metropolitan adults since 2008-2010 despite the implementation of substance use treatment and insurance expansion polices over this time period. Thus, additional policies and interventions are arguably warranted to further promote access to treatment and reduce the prevalence of drug use disorders in the U.S.

Rural and Underserved Health Research Center
Tyrone Borders, Hefei Wen