Rural jails struggle to screen and treat individuals with mental health and substance use disorders, with only 3% of eligible arrests leading to treatment. The most common path to care is post-arrest screening, especially for those with prior arrests. However, only 38.4% of referrals result in treatment, and males are less likely than females to participate, pointing to major gaps in access, outreach, and support.

Clackamas Health Centers (CHC), a Federally Qualified Health Center in Oregon, has offered medication for opioid use disorders (MOUD) for over a decade. CHC also provides MOUD to individuals involved with the criminal justice system. This evaluation examines how CHC's MOUD program implements low-barrier care.

Some evidence suggests that rural populations have a higher prevalence of depression and substance use disorder (SUD) than their urban counterparts. However, estimates for mental health conditions and SUDs in rural locations vary considerably depending on the measurement of rurality researchers use. The current study aims to empirically examine how the choice of rural measurements affects estimates of hospitalizations for depression and SUD in rural populations. Using several common methods for determining rurality, we examined how characteristics of “rural” patients hospitalized for depression or SUDs differ based on the definition of rurality used.

Examines rural telehealth use for SUD/OUD treatment, its impact on MOUD provision, and issues for sustaining telehealth-based care in rural communities.

Explores lived experiences of substance use stigma among rural Appalachian people who use drugs, focusing on stigma experiences, consequences, and coping responses.

People who use drugs and live in rural communities may lack access to harm reduction services. Harm reduction vending machines that offer 24/7 access to resources may help address this need. This study examines who in particular may be more or less likely to use a harm reduction vending machine in a sample of people using drugs in Appalachia.

Examines how right to counsel is implemented in Texas misdemeanor courts. Rural and poorer counties have higher non-representation rates, but local policy decisions (e.g., public defender offices, eligibility criteria) significantly affect appointment rates.

Increasing caregiver participation is crucial for youth success in community supervision, but probation officers struggle to engage caregivers, especially in high-need families. Interviews with legal staff reveal varying caregiver involvement, different engagement approaches, and barriers such as permissive substance use views and caregiver substance use.

Study of mental health call patterns in a rural county, showing stable hot spots and implications for police and mental health practitioners.

Using PRISM and RE-AIM models, this study describes how jail context features affect the number of people linked to MOUD and the sustainment of jail linkage programs, focusing on case studies in rural and urban Kentucky jails.

This study examines mental health care barriers for women with opioid use disorder in the criminal-legal system, highlighting shortages of psychiatrists and therapists, especially in smaller jails and rural areas.

This study examines the criminal legal systems of several sparsely populated counties in central and eastern Washington State. The study shows that a shortage of attorneys leads to delays and ineffective counsel for individuals involved in the system. Additionally, the heavy reliance on county governments to fund indigent defense, prosecution, and judicial functions creates financial strain. 

Describes a mail-based overdose education and naloxone distribution program for people on community supervision in Kentucky, noting benefits and sustainability challenges.

Video explores challenges for women reentering rural communities after incarceration and highlights innovative solutions like farm-based housing and reintegration initiatives.

Video examines North Carolina small towns innovative responses to mental health emergencies, homelessness, and low-level crime, featuring social worker ride-alongs and crisis support programs.

Describes a telehealth program (Moms IMPACTT) improving access to perinatal mental health and substance use care for rural and underserved populations.

Study describes houselessness among people who use drugs in rural communities across 10 states, addressing gaps in understanding rural drug use and harm.

Research on strains (victimization, homelessness, poor health) and opioid use among rural adolescents, applying general strain theory.

Study compares MOUD access and retention for rural youth (18-25) versus adults 26+, finding lower retention and unique barriers among youth.

Kansas report with recommendations to attract attorneys to rural areas and inspire students to pursue legal careers, addressing the rural justice gap.

Explores MAT (buprenorphine) capacity and access in rural areas after DATA waiver elimination, finding access increased but many more could be served if all providers prescribed to capacity.

Report on strategies rural communities use to attract and retain new clinicians, including training and peer support opportunities.

Study finds rural veterans less likely to receive methadone but more likely to receive buprenorphine for OUD, highlighting access disparities.

Report on barriers to domestic violence reporting in rural Pennsylvania, examining differences with urban areas and outcomes for victim-survivors.

Study on anger as a risk factor for adolescent violence in rural areas, emphasizing the need to address structural, community, and individual factors.

Study compares stigma toward opioid users among rural law enforcement and community members, highlighting challenges for overdose prevention and recovery.

Mixed-methods study in Kentucky highlights innovative telehealth approaches for connecting incarcerated women to MOUD at community re-entry.

RAIN established a rural hospital/clinic research network to implement evidence-based addiction prevention, treatment, and recovery services, using facilitators and community learning calls to overcome barriers.

Review analyzes rural access to justice, arguing more lawyers alone may not solve the crisis and exploring broader solutions for rural communities.

White paper highlights CCBHCs' role in expanding rural crisis access, leveraging local partnerships and flexible arrangements; includes rural-focused section.

In July 2024, the State Justice Institute (SJI), in partnership with the Institute for Intergovernmental Research (IIR) and the National Council of Juvenile and Family Court Judges (NCJFCJ) convened a 1-day listening session for judges and court personnel from rural communities to discuss barriers, successes, and innovations related to addressing substance use disorder (SUD) for court-involved people and to identify opportunities to more effectively support children and families impacted by SUD. This report summarizes highlights from that discussion, with a focus on strategies that are currently working well in rural courtrooms and an examination of ongoing challenges for rural judges and communities.

Interviews with peer workers and supervisors explore factors for successful implementation and optimization of peer support in mental health services.

This series highlights empirical research and solutions to improve health outcomes for rural individuals using drugs, including technology to address transportation and workforce shortages.

Report with recommended principles and practices for rural overdose prevention and response, aimed at local stakeholders.

Commentary on how clinicians can mitigate harm from MOUD disruption due to arrest or incarceration, recommending strategies for continuity of care.

Study of people with OUD released from jail in Massachusetts identifies risk and protective factors for post-release overdose, based on participant interviews.

Study of rural Vermont family members beliefs about OUD treatment finds skepticism about MOUD and highlights the importance of social support and stigma reduction.

Qualitative study of staff in rural Colorado jails identifies facilitators and barriers to MOUD adoption and expansion, including resource constraints and attitudes.

University of Minnesota study finds rural IPV victims face more barriers and need tailored resources and support for health and safety.

Study uses the EPIS framework to examine implementation of MOUD and peer support in probation settings, focusing on stakeholder perspectives and rural contexts.

Study finds rural SUD patients with commercial insurance face greater barriers to in-network care, leading to more out-of-network treatment and lower engagement rates.

Study in West Virginia links increased methamphetamine supply to rising opioid-methamphetamine co-use and overdose mortality in rural communities.

Study in West Virginia examines how transportation, Medicaid-funded NEMT, and telehealth affect access to MAT for OUD, highlighting rural barriers and solutions.

SAMHSA Treatment Improvement Protocol (TIP) offers guidance for integrating peer workers into SUD treatment, with specific considerations for rural programs and linking individuals to peer support.

This brief reviews activities undertaken by states to expand the use of telehealth for justice-involved individuals with SUDs during the COVID-19 pandemic, share lessons learned, and highlight considerations for governors who wish to leverage telehealth services to increase access to SUD treatment for those involved in the justice system.

Brief recommends expanding MOUD access for pregnant/parenting people in rural areas, using telehealth, mobile clinics, and family-centered approaches to keep families together.

Mental Health First Aid for Rural Communities teaches people how to notice and respond to signs of mental health and addiction challenges with a specific focus on the cultural and environmental factors related to life in rural areas. Mental Health First Aid is a course that teaches you how to identify, understand and respond to signs of mental illnesses and substance use disorders. The training gives you the skills you need to reach out and provide initial help and support to someone who may be developing a mental health or substance use problem or experiencing a crisis. 

Rural communities across the country are identifying ways to effectively implement youth- and family-focused programs to better serve individuals directly affected by SUD. This brief is one in a series highlighting projects that are part of the Rural Responses to the Opioid Epidemic (RROE) project.

Rural communities across the country are implementing solutions to these transportation challenges to better serve residents with SUD and make more efficient use of limited resources. This brief is one in a series highlighting projects that are part of the Rural Responses to the Opioid Epidemic (RROE) project.

Rural communities across the country are coming up with innovative ways to respond to overdose spikes in their communities through community outreach and response teams, which make contact with individuals and families who have experienced overdose to offer support and connections to services and treatment. This brief is one in a series highlighting projects that are part of the Rural Responses to the Opioid Epidemic (RROE) project.

Communities all over the country are implementing law enforcement- and first responder-led diversion efforts to redirect individuals with SUD, mental health disorders, and co-occurring disorders away from jail and the criminal justice system and into the care of community-based treatment programs. This brief is one in a series highlighting projects that are part of the Rural Responses to the Opioid Epidemic (RROE) project.

To combat the rising numbers of individuals with SUD, jails across the country have begun implementing jail-based programming to help incarcerated individuals as they seek recovery, reduce recidivism, and reduce the chances of overdose upon release. This brief is one in a series highlighting projects that are part of the Rural Responses to the Opioid Epidemic (RROE) project.

Rural communities across the country are implementing harm-reduction programs to better serve residents with substance use disorder (SUD) and make more efficient use of limited resources. This brief is one in a series highlighting projects that are part of the Rural Responses to the Opioid Epidemic (RROE) project.

Rural communities in all areas of the country are reaching out to their churches and faith-based organizations to bring them on as important partners and expand upon their outreach initiatives, as well as utilize the built-in resources many churches have, such as food pantries, clothing drives, and childcare services. This brief is one in a series highlighting projects that are part of the Rural Responses to the Opioid Epidemic (RROE) project.

Rural communities across the country are identifying ways to effectively partner with their local business community to better serve residents with substance use disorder (SUD) and make more efficient use of limited resources. This brief is one in a series highlighting projects that are part of the Rural Responses to the Opioid Epidemic (RROE) project.

This action brief provides rural communities recommended strategies for adapting promising or proven interventions to better support crisis response and pre-arrest diversion in their communities. It is the first of three briefs developed from the Substance Abuse and Mental Health Services Administration (SAMHSA) Prearrest Diversion Expert Panel.

Rural communities face unique challenges in responding to incidences of domestic violence, due to geographic isolation and a lack of resources, among other factors. Such challenges make it difficult for survivors in rural areas to seek safety. These 10 practices for criminal courts in rural communities offer strategies to protect survivors’ safety and well-being, engage with abusive partners and hold them accountable, and collaborate within the community.

Communities nationwide are grappling with a growing opioid crisis, particularly in the Appalachian region, where overdose death rates were 72% higher in 2017 than in non-Appalachian areas. Local leaders have struggled to address rising addiction and overdoses, prompting this report to analyze the epidemic's impact and offer targeted recommendations in five areas: leadership, prevention, recovery, rehabilitation for justice-involved individuals, and economic development, each supported by case studies from Appalachian counties.

Information on barriers to treatment for Opioid Use Disorder in rural areas and what some states are doing to overcome those barriers.

Collaboration between state and tribal courts regarding the opioid crisis.

Information on barriers to treatment for Opioid Use Disorder in rural areas and what some states are doing to overcome those barriers.

Document designed and recommended for use in jurisdictions where state court judges – especially those who preside over adult drug court programs – operate in proximity to the location of a Tribal Healing to Wellness Court.

This infographic visually displays the tools that USDA Rural Development can offer to help rural America respond to the opioid epidemic.