Substance use and treatment: Rural Health Research Products & Journal Articles

2023

Factors Associated With Hospitalizations for Co-occurring HIV and Opioid-related Diagnoses: Evidence From the National Inpatient Sample, 2009-2017
Journal Article
Southwest Rural Health Research Center
Date: 05/2023
This study explores trends in co-occurring HIV and opioid-related hospitalizations and identifies key risk factors.
Factors Associated With Lengths-of-Stay for Inpatients With Substance Use Disorders
Policy Brief
Rural Health Equity Research Center
Date: 04/2023
This policy brief identifies factors associated with inpatient length-of-stay (LOS) for the treatment of substance use disorders (SUDs), and whether there are systematic differences in LOS for rural and urban residents.
Rural and Urban Differences in Factors Associated With Inpatient Hospital Stays for Substance Use Disorder
Policy Brief
Rural Health Equity Research Center
Date: 04/2023
Using 2018 all-payer claims data from seven states, this brief describes the lengths and costs of inpatient hospital stays for substance use disorders and examines whether there were differences between stays for rural and urban residents.

2022

Medicaid Expansion and Access to Naloxone in Metropolitan and Nonmetropolitan Areas
Journal Article
Rural and Underserved Health Research Center
Date: 11/2022
This study evaluated the association of Medicaid expansion at the state level on the number of naloxone prescriptions dispensed and the percentage paid by Medicaid. Increasing the percentage of Medicaid-paid naloxone prescriptions improved access in metro areas.
Availability of Substance Use Disorder Treatment in Minoritized Racial/Ethnic Group Areas
Policy Brief
Rural and Minority Health Research Center
Date: 09/2022
This brief is one of a series of findings briefs documenting disparities in geographic access to health services for ZIP code tabulation areas (ZCTAs) containing a high proportion of minoritized racial/ethnic residents. This report looks at spatial availability and travel burden for substance use disorder care at the ZCTA level.
Non-Metropolitan and Metropolitan Trends in Mental Health Treatment Availability in Community Health and Community Mental Health Centers
Policy Brief
Rural and Underserved Health Research Center
Date: 06/2022
This study shows how the supply of community mental health centers (CMHCs) and community health centers (CHCs) delivering mental health services changed from 2000 to 2019. While the supply of CHCs offering mental health services increased, the supply of CMHCs decreased.
Serious Mental Illness and Mental Health Treatment Utilization Among Adults Residing in Non-Metropolitan and Metropolitan Counties
Policy Brief
Rural and Underserved Health Research Center
Date: 02/2022
This report estimates and compares the prevalence of mental health treatment utilization and reasons for not seeking mental health treatment among adults with serious mental illness residing in non-metropolitan and metropolitan counties nationally.

2021

Use of Electronic Health Records to Manage Tobacco Screening and Treatment in Rural Primary Care
Journal Article
Maine Rural Health Research Center
Date: 09/2021
This study compares the performance of rural and urban primary care providers in adhering to evidence-based smoking-related standards of care and assesses the degree to which electronic health record use was related to improved adherence to these standards in the practice of rural versus urban providers.
Medicare-Paid Naloxone: Trends in Nonmetropolitan and Metropolitan Areas
Policy Brief
Rural and Underserved Health Research Center
Date: 05/2021
Naloxone is an opioid overdose reversal medication. Medicare beneficiaries benefit from access to naloxone because they have high rates of high-dose prescription opioids. This brief examines trends in Medicare-paid naloxone dispensing rates in nonmetropolitan versus metropolitan areas from 2014 to 2018.
Voices From the Field: A Qualitative Study of the Challenges and Promising Practices of Rural Public Health in Addressing HIV and Hepatitis C
Journal Article
Maine Rural Health Research Center
Date: 05/2021
Interviewing public health professionals from six rural states, researchers examined the challenges involving HIV, HCV, and serving rural people who inject drugs and determined strategies to address those challenges.
Tracking the Geographic Distribution and Growth of Clinicians With a DEA Waiver to Prescribe Buprenorphine to Treat Opioid Use Disorder
Journal Article
WWAMI Rural Health Research Center
Date: 03/2021
The increase in clinicians who can prescribe buprenorphine improves access to treatment for opioid use disorder. Small remote rural communities continue to experience access challenges. 63.1% of all rural counties had at least one clinician with a Drug Enforcement Administration waiver, but more than half of small remote rural counties did not.
Capacity of Rural Counties to Address an HIV or Hepatitis C Outbreak
Policy Brief
Maine Rural Health Research Center
Date: 02/2021
This study examines rural-urban differences in state and local health department capacity to prevent, prepare for, and respond to an HIV or hepatitis C outbreak.
Opioid-Related Visits to Rural Emergency Departments
Policy Brief
Maine Rural Health Research Center
Date: 02/2021
The purpose of this project was to compare rural and urban opioid-related emergency department visits. Data from the Nationwide Emergency Department Sample were used to examine rural and urban opioid-related visits over time and to compare the outcomes of these visits.
Rural HIV Prevalence and Service Availability in the United States: A Chartbook
Chartbook
Maine Rural Health Research Center
Date: 02/2021
This chartbook examines 2016 HIV prevalence and the availability of HIV prevention, testing, and treatment services across the rural-urban continuum and by U.S. census region.
Rural-Urban Residence and Maternal Hepatitis C Infection, U.S.: 2010-2018
Journal Article
Maine Rural Health Research Center
Date: 02/2021
This study uses data from the U.S. natality files to examine rural-urban differences in county-level rates of maternal infection with hepatitis C virus (HCV) during 2010-2018. Findings can help inform implementation of community-level interventions to reduce maternal HCV infection and narrow rural-urban disparities.

2020

Risky Substance Use Behaviors Among Adolescents Residing in Nonmetropolitan and Metropolitan Counties in the United States, 2017-2018
Policy Brief
Rural and Underserved Health Research Center
Date: 11/2020
This brief uses nationally representative survey data to compare past-30 day and past-year risky substance use among adolescents 12 to 17 years of age residing in metropolitan and nonmetropolitan counties. Specifically, we compared consumption of alcohol, tobacco, and other illicit substances.
Risky Substance Use Behaviors Among Adults Residing in Nonmetropolitan and Metropolitan Counties in the United States, 2017-2018
Policy Brief
Rural and Underserved Health Research Center
Date: 11/2020
This brief uses nationally representative survey data to identify differences in past-30 day and past-year risky substance use among adults, including alcohol, tobacco, and illicit drugs. This data indicates some significant differences in substance use consumption.
Substance Use Among Rural and Urban Youth and Young Adults
Policy Brief
Maine Rural Health Research Center
Date: 11/2020
This study uses national data to examine rural-urban differences in the rates of substance use among youth and young adults. Findings can help inform rural-specific prevention strategies and research targeting rural communities.
Major Depression, Treatment Receipt, and Treatment Sources Among Non-Metropolitan and Metropolitan Adults
Policy Brief
Rural and Underserved Health Research Center
Date: 06/2020
This study estimates and compares the prevalence of past year depression, receipt of treatment for depression, and sources of treatment for depression between non-metropolitan and metropolitan adults.
Measure and Data Element Identification for the HRSA Evidence-Based Tele-Behavioral Health Network Program and the HRSA Substance Abuse Treatment Telehealth Network Grant Program
Policy Brief
Rural Telehealth Research Center
Date: 04/2020
This brief details work to identify measures and develop data elements appropriate to tele-behavioral health, create an Excel-based tool, and collect data from grantees in the Health Resources and Services Administration's Evidence-Based Tele-Behavioral Health Network Grant Program and Substance Abuse Treatment Telehealth Network Grant Program.
Early-Career and Graduating Physicians More Likely to Prescribe Buprenorphine
Journal Article
Rural and Underserved Health Research Center
Date: 01/2020
Only a small percentage of people who need treatment for opioid use disorder receive it, including buprenorphine. This paper shows differences in rates of prescribing buprenorphine and intentions to prescribe buprenorphine between early- and mid-to-late career family physicians, based on a survey of physicians taking a certification examination.
Practice Predictors of Buprenorphine Prescribing by Family Physicians
Journal Article
Rural and Underserved Health Research Center
Date: 01/2020
Physicians may prescribe buprenorphine if they obtain a waiver, but relatively few family physicians do so. This paper examines the association between practice characteristics and the likelihood that a family physician will prescribe buprenorphine, based on a survey of physicians seeking board certification in family medicine.

2019

Partial Psychiatric Hospitalization Program Availability in Nonmetropolitan and Metropolitan Hospitals Nationally
Policy Brief
Rural and Underserved Health Research Center
Date: 12/2019
Partial psychiatric hospitalization programs (PPHPs) are intended to reduce or avoid inpatient stays by providing intensive psychiatric services in outpatient settings. We provide national estimates of PPHP availability among nonmetropolitan and metropolitan hospitals and describe the hospital characteristics associated with the provision of PPHPs.
Prescribing Practices of Nurse Practitioners and Physician Assistants Waivered to Prescribe Buprenorphine and the Barriers They Experience Prescribing Buprenorphine
Journal Article
WWAMI Rural Health Research Center
Date: 10/2019
This study surveyed rural and urban nurse practitioners (NPs) and physician assistants (PAs) with Drug Enforcement Agency waivers to provide medication treatment for opioid use disorder by prescribing buprenorphine. Rural NPs and PAs reported facing many of the same barriers to providing buprenorphine as rural physicians have reported.
Suicidal Thoughts, Plans, and Attempts by Non-Metropolitan and Metropolitan Residence
Policy Brief
Rural and Underserved Health Research Center
Date: 05/2019
Suicide is among the leading causes of death in the US, and rates in non-metropolitan (rural) counties have historically exceeded those in metropolitan (urban) counties. This study examined the prevalence of suicidal thoughts, plans, and attempts by year (2010-2016) and county type (non-metropolitan, small metropolitan, and large metropolitan).
Rural-Urban Differences in the Decline of Adolescent Cigarette Smoking
Journal Article
Maine Rural Health Research Center
Date: 03/2019
Comparing survey data from 2008-2010 with 2014-2016, we examined change over time in cigarette smoking among rural and urban adolescents. We found that both rural and urban rates declined, but the decrease was smaller in rural counties, which widened the rural-urban gap in adolescent smoking rates.

2018

Overcoming Barriers to Prescribing Buprenorphine for the Treatment of Opioid Use Disorder: Recommendations From Rural Physicians
Journal Article
WWAMI Rural Health Research Center
Date: 10/2018
Rural physicians with a Drug Enforcement Administration waiver to prescribe buprenorphine who were treating a higher than average number of opioid use disorder patients were interviewed about strategies and best practices for overcoming commonly cited barriers to incorporating and providing medication assisted treatment into their practices.
Practical Implications: Opioid-Affected Births to Rural Residents
Policy Brief
University of Minnesota Rural Health Research Center
Date: 09/2018
This publication provides two physicians' reactions to research findings on rates of diagnosis of maternal opioid use disorder and infant neonatal abstinence syndrome at the time of childbirth for rural residents based on the type of hospital where the birth occurred.
Non-Medical Opioid Use Among Rural and Urban Pregnant Women, 2007-2014
Policy Brief
University of Minnesota Rural Health Research Center
Date: 08/2018
This policy brief presents data on rural-urban differences in non-medical opioid use among pregnant women to inform policy, programmatic, and clinical efforts to address this crisis.
Projected Contributions of Nurse Practitioners and Physicians Assistants to Buprenorphine Treatment Services for Opioid Use Disorder in Rural Areas
Journal Article
WWAMI Rural Health Research Center
Date: 08/2018
This study projected the potential increase in medication assisted treatment availability for opioid use disorder (OUD) provided by nurse practitioners (NPs) and physician assistants (PAs) for rural patients under the Comprehensive Addiction and Recovery Act, which allows NPs and PAs to obtain a waiver to prescribe buprenorphine for OUD.
Geographic Distribution of Providers With a DEA Waiver to Prescribe Buprenorphine for the Treatment of Opioid Use Disorder: A 5‐Year Update
Journal Article
WWAMI Rural Health Research Center
Date: 06/2018
This study compares the geographic distribution of physicians, physician assistants, and nurse practitioners waivered to prescribe buprenorphine in 2012 and 2017.
Geographic Variation in the Supply of Selected Behavioral Health Providers
Journal Article
WWAMI Rural Health Research Center
Date: 06/2018
This study examined the supply of select behavioral health providers by metropolitan, micropolitan, and non-core county and Census Division. Psychiatrists, psychologists, and psychiatric nurse practitioners are unequally distributed throughout the U.S., with disparities between Census Divisions and rural vs. urban areas.
Prescribing Practices of Rural Physicians Waivered to Prescribe Buprenorphine
Journal Article
WWAMI Rural Health Research Center
Date: 06/2018
This study finds more than 60% of rural counties don't have a physician waivered to prescribe buprenorphine, which is used to treat opioid use disorder.
Illicit Drug and Opioid Use Disorders Among Non-Metropolitan Residents
Policy Brief
Rural and Underserved Health Research Center
Date: 01/2018
We provide estimates of the prevalence of illicit drug and opioid use disorders among non-metropolitan adults ages 18-64. Prevalence rates did not decline from 2011-2013 to 2014-2015 despite the implementation of major substance use treatment policies. Of particular concern, heroin use disorder prevalence increased in recent years.
Perceived Treatment Need and Utilization for Illicit Drug and Opioid Use Disorders in Non-Metropolitan Areas
Policy Brief
Rural and Underserved Health Research Center
Date: 01/2018
The vast majority of non-metropolitan adults 18-64 who satisfy criteria for an illicit drug use or opioid use disorder do not perceive a need for treatment or receive formal substance use treatment. Despite policies to increase treatment access during the 2008-2015 study period, we found few changes in perceived treatment need and utilization.

2017

Barriers Rural Physicians Face Prescribing Buprenorphine for Opioid Use Disorder
Journal Article
WWAMI Rural Health Research Center
Date: 07/2017
Opioid use disorder is a serious public health problem. Management with buprenorphine is an effective medication-assisted treatment, but 60.1% of rural counties lack a physician with a Drug Enforcement Agency waiver to prescribe buprenorphine. This national study surveyed all rural physicians who have received a waiver in the United States.
Use of the Emergency Department for Mental Health and Substance Abuse Among Women
Fact Sheet
North Dakota and NORC Rural Health Reform Policy Research Center
Date: 07/2017
This study identifies trends among women in rural and urban communities who utilize the emergency department for mental health and substance abuse. The information can be used to help communities provide more relevant, appropriate, and less costly care.
Changes in the Supply of Physicians With a DEA DATA Waiver to Prescribe Buprenorphine for Opioid Use Disorder
Policy Brief
WWAMI Rural Health Research Center
Date: 05/2017
This project mapped the location of physicians with a DEA DATA 2000 waiver to prescribe buprenorphine for opioid use disorder in July 2012 and April 2016. The number of counties without a waivered physician and the ratio of waivered physicians per 100,000 population is reported by the rural/urban status of the county.
Rural Opioid Abuse Prevention and Treatment Strategies: The Experience in Four States
Policy Brief
Maine Rural Health Research Center
Date: 04/2017
Little is known about what states with large rural populations are doing to combat opioid use disorders (OUD) in rural communities. This qualitative study identified rural challenges to the provision of OUD prevention, treatment, and recovery services and explored promising strategies to tackle the opioid crisis in rural communities.

2016

Rural Opioid Abuse: Prevalence and User Characteristics
Policy Brief
Maine Rural Health Research Center
Date: 02/2016
Opioid abuse is the fastest growing substance abuse problem in the nation and the primary cause of unintentional drug overdose deaths. This study examined the rural-urban prevalence of non-medical use of pain relievers and heroin in the past year and the socioeconomic characteristics associated with their use and other risky behavior.

2015

Geographic and Specialty Distribution of U.S. Physicians Trained to Treat Opioid Use Disorder
Journal Article
WWAMI Rural Health Research Center
Date: 01/2015
Examines the distribution of physicians authorized to treat opioid use disorder in the United States, and proposes increasing access to office-based treatment as a promising strategy to address rising rates of opioid use disorder in rural areas.

2014

The 2014 Update of the Rural-Urban Chartbook
Chartbook
North Dakota and NORC Rural Health Reform Policy Research Center
Date: 10/2014
This chartbook includes trends and disparities in urban/rural health. Reports on population characteristics include age, race and ethnicity, and poverty; risk factors such as smoking, alcohol use, and obesity; mortality data; health status measures such as adolescent births and total tooth loss; healthcare access/use; and mental health measures.

2012

Adolescent Alcohol Use: Do Risk and Protective Factors Explain Rural-Urban Differences? (Policy Brief)
Maine Rural Health Research Center
Date: 03/2012
This policy brief finds that after controlling for a broad range of key risk and protective factors, it is clear that an unexplained rural effect persists with rural adolescents still exhibiting higher alcohol use than their urban counterparts.
Adolescent Alcohol Use: Do Risk and Protective Factors Explain Rural-Urban Differences? (Working Paper)
Maine Rural Health Research Center
Date: 03/2012
This study examines alcohol use among rural and urban adolescents between the ages of 12 and 17.

2009

Availability, Characteristics, and Role of Detoxification Services in Rural Areas
Maine Rural Health Research Center
Date: 12/2009
Few detox providers (n=235) serve rural America; 82% of rural residents live in a county without a detox provider. More than half of all rural detox providers serve patients across a 100-mile radius, making travel distances a barrier to outpatient care. Referral options to substance abuse treatment are limited, especially in isolated rural areas.
Few and Far Away: Detoxification Services in Rural Areas (Research & Policy Brief)
Maine Rural Health Research Center
Date: 12/2009
This policy brief finds that few rural detox providers exist; 82% of rural residents live in a county without a detox provider. More than half of all rural detox providers serve a 100-mile radius. Travel distances are a barrier to outpatient detox models. Referral options to substance abuse treatment are limited, especially in isolated rural areas.

2008

Distribution of Substance Abuse Treatment Facilities Across the Rural - Urban Continuum (Research & Policy Brief)
Policy Brief
Maine Rural Health Research Center
Date: 02/2008
This research and policy brief highlights findings from a recent study examining the distribution of substance abuse treatment facilities in rural and urban counties and identifying the type and intensity of services provided.

2007

Distribution of Substance Abuse Treatment Facilities Across the Rural - Urban Continuum
Maine Rural Health Research Center
Date: 10/2007
This study examines the distribution of substance abuse treatment services across the continuum of rural and urban counties, identifying the type and intensity of services provided.
Substance Abuse Among Rural Youth: A Little Meth and a Lot of Booze
Maine Rural Health Research Center
Date: 06/2007
This research and policy brief examines substance abuse among rural youth, with rural-urban comparisons of methamphetamine, Oxycontin, and alcohol abuse.

2006

Problem Drinking: Rural and Urban Trends in America, 1995/1997 to 2003
Journal Article
WWAMI Rural Health Research Center
Date: 03/2006
Assesses the prevalence of, and recent trends in, alcohol use among adults 18 years and older in rural areas of the United States. The paper finds that heavy drinking was highest and increasing in urban areas, but that binge drinking was greater in rural areas. It recommends tailoring interventions specifically to meet the needs of rural residents.
Prevalence and Trends in Smoking: A National Rural Study
Journal Article
WWAMI Rural Health Research Center
Date: 2006
Using data from the Behavioral Risk Factor Surveillance System, the prevalence of smoking between 1994-1996 and 2000-2001 did not change substantially for the United States as a whole. The prevalence of smoking for rural residents decreased by more than 2 percent in six states. However, it increased by 2 percent or more in ten states.
PTSD and Substance Use: Unrecognized Sequelae of Bioterrorism in Primary Care Providers
Journal Article
FORHP-funded Individual Grantees
Date: 2006
Study looks at rural primary care providers' knowledge of likely mental disorders, their risk factors, and preferred treatment options following a public health emergency.
Rural and Frontier Mental and Behavioral Health Care: Barriers, Effective Policy Strategies, Best Practices
Maine Rural Health Research Center
Date: 2006
This report discusses barriers to mental and behavioral health service delivery in rural America. It includes model programs and model policy strategies for rural mental and behavioral healthcare delivery and discusses the roles that telehealth and that the State Offices of Rural Health should play in service delivery.

2005

Early Alcohol Use, Rural Residence, and Adulthood Employment
Rural and Minority Health Research Center
Date: 10/2005
Findings indicate that drinking during youth and early adulthood was common in the early 1980s. Nearly half of respondents reported drinking before age 18, and 55.3% reported binge drinking. Drinking behaviors did not differ significantly between rural and urban residents.
Violence and Rural Teens: Teen Violence, Drug Use, and School-Based Prevention Services in Rural America
Rural and Minority Health Research Center
Date: 03/2005
This report describes a study to explore the prevalence of violence-related exposures and drug use among rural teens, to investigate the effects of race and gender on the risk of exposure to violence and drug use, and to compare the policies and mental healthcare services of rural and urban schools.
Violence and Rural Teens: Teen Violence, Drug Use, and School-Based Prevention Services in Rural America (Fact Sheet)
Fact Sheet
Rural and Minority Health Research Center
Date: 2005
This fact sheet covers the key findings from a study of violence and drug use among rural teens.

2003

Prevalence of Health Related Behavioral Risk Factors Among Non-Metro Minority Adults
Rural and Minority Health Research Center
Date: 08/2003
Data is shared on tobacco use, seat belt use, and alcohol consumption among rural minority adults. It includes recommendations and detailed data tables.
Behavioral Risk Factors Among Rural African Americans
Fact Sheet
Rural and Minority Health Research Center
Date: 2003
This fact sheet discusses seat belt use, tobacco use, and alcohol use among rural African Americans.
Behavioral Risk Factors Among Rural Hispanics
Fact Sheet
Rural and Minority Health Research Center
Date: 2003
This fact sheet discusses seat belt use, tobacco use, and alcohol use among rural Hispanics.
Rural-Urban Difference in Health Care Benefits of Community-Based Sample of At-Risk Drinkers
Journal Article
WICHE Center for Rural Mental Health Research
Date: 2003
Compares the cost-containment strategies used by health plans of insured at-risk drinkers residing in rural and urban areas.