Drug overdoses are the leading cause of unintentional injury in the United States. In 2014, there were 47,055 drug overdose deaths in the United States with 61% involving an opioid.1 But are some areas being disproportionately affected? According to a recent analysis by the Center for Disease Control and Prevention, nonmetropolitan rural areas have higher rates of opioid-related deaths.2 Additionally, rural areas have some of the highest opiate-prescribing rates in the country. Of the 15 counties who have the highest rates of opiate prescription, 14 of the counties are considered rural.

Unique issues create unique challenges

Rural area citizens experience unique health disparities that impact their ability to access treatment. Three key underlying factors include mental health issues, insufficient access to healthcare facilities, and a provider shortage.

Mental Health: Approximately 1 in 5 rural adult citizens reported having a mental health disorder.3 Additionally, 5% of rural residents report serious thoughts of suicide. This is important because many of those who are diagnosed with mental health also experience substance abuse related issues.4

Healthcare Access: Rural Americans live an average of 10.5 miles or 17 minutes from the nearest hospital, which is about twice as far when compared to those who live in suburban or urban areas.5 They are also less likely to have specialized care centers, such as mental health or substance abuse treatment facilities. Unfortunately, but unsurprisingly, research suggests living in rural areas were less likely to receive follow-up care compared to their urban counterparts.6

Provider Availability: The patient-to-primary care physician ratio in rural areas is only 39.8 physicians per 100,000 people, compared to 53.3 physicians per 100,000 in urban areas. This is significant because it places stricter time constraints on the provider and affects the patient-provider relationship. According to a 2017 study, doctors in rural areas spend eight minutes less time with their patients as compared to doctors in urban areas.7

How do these underlying issues stack up?

Accessibility, engagement, and availability barriers have a high impact on care coordination and the continuum of care. They make it difficult to treat diseases that require a high amount of provider-to-patient contact and specialized treatment. Because those living in rural areas are more likely to have worse health outcomes, many patients are already labeled “at-risk”. With a patient-to-provider ratio demonstrating a shortage of care and specialization, rural providers are forced to treat sicker patients with fewer resources available.8

The data tells us that patients in rural areas are more likely to receive an opiate prescription as compared to those in urban areas.9 However, the aforementioned access and availability research suggest these patients are less likely to get the clinical management and support they need to manage their medications and co-occurring conditions. They also may not have access to adequate care resources if something starts going wrong.

What if you could provide support between visits?

Opioid prescription management requires an interdisciplinary approach and an immense amount of patient support to prevent opioid misuse and addiction.10 Those who are receiving opioid prescriptions need more touchpoints to help manage their medications. Those who have low awareness of opioid-related complications are even more at risk, with high needs for support. Unfortunately, rural physicians often lack the resources to provide the extra time required for opioid-prescribed patients. With an influx of patients, many of which require complex care, additional care time can be an almost impossible task.

This is where digital health coaching comes into play. Consistent support from a digital health coach can provide the in-between care the rural areas need. A weekly 15 minutes call can help patients learn more about their prescriptions, ensure adherence, and help provide alternatives to pain management.  At Pack Health, our Chronic Pain and Prescribed Opioid Program provides support for patients who are prescribed an opioid manage their prescriptions and help provide support to prevent prescription misuse.

It’s essential to consider social determinants (i.e. where people live, etc.) in treatment. Social determinants impact the way that patients are able to manage chronic conditions and prescriptions. By understanding these determinants, we can improve quality of care and reduce barriers to help prevent misuse and overdose.

Updated 8/2/2023

Written by Brittney Vigna, MPH, CHES, CPH, Marketing Manager

  1. Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015. MMWR Morb Mortal Wkly Rep 2016;65:1445–1452. DOI: http://dx.doi.org/10.15585/mmwr.mm655051e1external icon.
  2. García MC, Heilig CM, Lee SH, et al. Opioid Prescribing Rates in Nonmetropolitan and Metropolitan Counties Among Primary Care Providers Using an Electronic Health Record System — United States, 2014–2017. MMWR Morb Mortal Wkly Rep 2019;68:25–30. DOI: http://dx.doi.org/10.15585/mmwr.mm6802a1.
  3. Rural Health Information Hub. Rural Mental Health. Accessed August 2, 2023. https://www.ruralhealthinfo.org/topics/mental-health#workforce-challenges
  4. Substance Abuse and Mental Health Services Administration. Mental Health and Substance Use Co-Occurring Disorders. Last Updated April 24, 2023. Accessed August 2, 2023. https://www.samhsa.gov/mental-health/mental-health-substance-use-co-occurring-disorders
  5. American Hospital Association. Study: Rural residents travel about twice as far to hospital on average. December 14, 2018. Accessed August 2, 2023. https://www.aha.org/news/headline/2018-12-14-study-rural-residents-travel-about-twice-far-hospital-average
  6. Toth M, Holmes M, Van Houtven C, Toles M, Weinberger M, Silberman P. Rural Medicare Beneficiaries Have Fewer Follow-up Visits and Greater Emergency Department Use Postdischarge. Medical Care 53(9):p 800-808, September 2015. | DOI: 10.1097/MLR.0000000000000401
  7. Banerjee T, Nayak A. Rural-Urban Differences in Durations of Patient-Physician Visit Time. Economic Bulletin, Volume 37, Issue 2. Accessed August 2, 2023. http://www.accessecon.com/Pubs/EB/2017/Volume37/EB-17-V37-I2-P107.pdf
  8. Remster EN, Marx TL. Barriers to Managing Chronic Pain: A Pilot of Prescriber Perceptions in Rural Appalachia. Journal of Pain and Symptom Management. Vol 36, No 3. Accessed August 2, 2023. https://www.jpsmjournal.com/article/S0885-3924(08)00300-X/pdf
  9. García MC, Heilig CM, Lee SH, et al. Opioid Prescribing Rates in Nonmetropolitan and Metropolitan Counties Among Primary Care Providers Using an Electronic Health Record System — United States, 2014–2017. MMWR Morb Mortal Wkly Rep 2019;68:25–30. DOI: http://dx.doi.org/10.15585/mmwr.mm6802a1.
  10. Parchman ML, Von Korff M, Baldwin LM, et al. Primary Care Clinic Re-Design for Prescription Opioid Management. J Am Board Fam Med. 2017;30(1):44-51. doi:10.3122/jabfm.2017.01.160183