Opioid use disorder and rural America

Abstract Rural communities continue to be among the most vulnerable and hardest hit by the current opioid epidemic in the United States. Inaccessible and inadequately organized healthcare and addiction treatment services leave residents of many rural communities vulnerable to the preventable harms of opioid misuse, addiction, and the syndemics associated with injection drug use (IDU), such as hepatitis B and C, endocarditis, and HIV. Understanding the unique factors and barriers in rural communities is important for informing and implementing public health programs and treatment for opioid use disorder (OUD). In this chapter, we describe the shifts in burden patterns associated with OUD and IDU in rural areas, their causes, and barriers to treatment. Lastly, we will discuss promising models for medication-assisted treatment and prevention and treatment of the infectious disease consequences of OUD and IDU in a resource-limited rural setting.