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.

This webinar explores challenges and solutions related to mental health outreach in rural communities. It features insights from experts who share their experiences addressing stigma, building trust, and expanding access to mental health care in rural areas. The session highlights the importance of culturally sensitive approaches, trusted community messengers, and sustainable programs tailored to rural populations.

California is one of just five states in which the rate of death from drug overdoses is higher in rural areas than urban ones. In the California Health Report, PHI’s Bridge Center is highlighted for its program, which trains EMS units to administer medications that help withdrawal symptoms, helping to reach the state’s rural populations with critical care.

This evaluation and report provide findings from an initiative integrating nonclinical adult mental health supports into rural libraries. The report is intended for community members and leaders interested in implementing nonclinical mental health support within libraries or other community spaces to expand the mental health workforce. A related toolkit offers guidance for librarians on identifying and initiating mental health supports within libraries to assist patrons with their mental well-being.

The California-based La Maida Project announced this month that it is working with Save the Children to build and implement a training network that will support rural early- childhood educators and their youngest learners. By taking an ecological approach to mental health, the partnership seeks to help both the children and their caregivers.

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.

This episode explores the landscape of opioid overdose in the rural areas of North Idaho and Northwest Washington, and highlights the tragic story of Jasmine Martin, a 23-year-old who died from an overdose in 2024 while trying to get sober. The conversation explores the availability of recovery resources, stigmas surrounding addiction, and the complexities of fentanyl use in small communities. (Jasmine’s story, min. 11:18)

With opioid addiction continuing to affect thousands of residents in Maine each year, Seaport Community Health Center (SCHC) in Belfast, a rural area of Maine, is initiating a trial for a new treatment that may significantly enhance access and consistency for individuals struggling with opioid use disorder. SCHC is among several sites involved in a nationwide study assessing the efficacy of Brixadi, an injectable medication designed to treat opioid addiction. Unlike traditional medications such as Suboxone, which require daily administration under the tongue, Brixadi is administered monthly.

In rural areas like Warrick County, addiction — particularly to opioids and methamphetamine — has touched nearly every family in some way. Traditional jail sentences often don’t solve the problem. In fact, in many cases, they make it worse. A person struggling with addiction might serve time, only to be released and fall right back into the same habits, the same crowd, the same pain. That’s where drug courts come in.

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

Access to youth and adolescent behavioral health care is a major challenge facing rural communities. In this conversation, Adrienne Coopey, D.O., a child and adolescent psychiatrist at the West Virginia University Rockefeller Neuroscience Institute, discusses how a fully virtual collaborative care model is helping deliver early behavioral health interventions and improve access and outcomes for children across West Virginia.

This article examines how individuals in Montana and across the United States are often identified by the alleged crimes they are charged with, rather than by their personal histories or circumstances. It describes ongoing efforts to address this issue, such as a collaboration between Bail Disruptor Riley and the Confederated Salish & Kootenai Tribes on the Flathead Reservation. Working with the Tribal Defenders Office, which uses a holistic defense approach, Riley offers support that acknowledges each person's unique background, needs, and goals.

Narcan dispensing boxes are becoming common in Missouri to combat opioid overdoses. Officials stress the need for more addiction treatment services, better access to treatment, and improved coordination between emergency services and long-term care, especially in rural areas.

If we pretend that everyone that has made a mistake...should get some sort of economic death penalty where they can never get a job again, we will never overcome this problem.' Harlan County, Kentucky, a rural area with high overdose rates, is emerging as a model for addiction recovery. The county has implemented various recovery programs, drug courts, and transportation services, all funded by opioid settlement money. 

In southeast Kansas, home to the highest poverty rates in the state, collaborative solutions tailored to the needs of the community have proven successful in addressing homelessness and healthcare. The Community Health Center of Southeast Kansas offers care to the region regardless of a patient’s ability to pay. The center is one example among several rural solutions across the state, filling in the coverage gap and fostering healthier communities.

This webinar explores the unique challenges rural communities face in accessing crisis services, from geographic barriers to limited resources. Experts share strategies and promising practices for strengthening rural crisis systems, including insights on implementing the 988-crisis line in rural settings. Real-world examples highlight effective solutions to improve accessibility and ensure timely support for rural populations.

To assist rural communities in effectively communicating overdose prevention, the Berkeley Media Studies Group (BMSG) offers comprehensive insights on how this topic is framed within rural contexts. Their presentation covers key components, including messaging strategies (beginning at 9:49), methods for framing and reframing the issue (16:28), utilization of Lakoff’s Levels of Framing (22:21), relevant research findings (25:16), techniques for message development (30:03), and recommendations for selecting effective messengers and communication practices (36:18).

Noble County, Ohio, received opioid settlement funds, insufficient for large projects, so rural areas strategize to maximize impact with limited resources.

Discusses how rural housing agencies and advocates use available resources and state programs to stabilize housing and address eviction, jobs, transportation, and mental health in small towns.

Arizona Center for Rural Health webinar on recognizing overdose, administering naloxone, self-care for witnesses, resilience strategies, and fostering safe environments for overdose prevention and recovery. Includes training and stigma-reduction segments.

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 webinar explores challenges rural community pharmacies face in dispensing medications for opioid use disorder (MOUD). Participants learn about barriers impacting MOUD access and discover practical resources and strategies to help expand treatment availability. 

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.

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.

Discusses hidden fentanyl use in rural Oregon and a new deflection program to divert people from misdemeanor charges into treatment.

Gallatin County's mobile crisis response team serves as a model for rural crisis response, focusing on identification, partnerships, creative solutions, and data-driven performance.

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

Podcast episode on Somerset County Jail's innovative addiction treatment program and its impact on inmates and the rural community.

Study of The Family Check-Up, an online parenting program for rural parents with mental health or substance use issues, showing reduced depression and improved parenting skills.

Toolkit for expanding access to naloxone and other overdose reversal medications, providing guidance for communities to develop effective prevention and response strategies.

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

Podcast episode explores stigma and healthcare access challenges for people with SUD in Appalachia, frameworks for understanding beliefs, and ways to address internalized stigma in healthcare and communities.

Community media project in Central Appalachia supports communication and healing for families and communities affected by mass incarceration.

Resource hub offers best practices, policies, trackers, and tools for effective use of opioid settlement funds, including naloxone calculators and assessment toolkits.

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

Discusses rural homelessness in Wisconsin, hidden forms of homelessness, and solutions such as new rental units, funding, and case management.

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.

This podcast series tells the stories of participants in Galax, Virginia's Recovery Court, focusing on opioid crisis impacts and rehabilitation.

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

The MOMS program in Minnesota helps parents recover from opioid abuse and thrive, offering lessons for other communities.

The Vera Institute of Justice Incarceration Trends website includes more than five decades of local jail and state prison data at the national, state, and county levels.  

Rural survivors face major barriers to safety due to sparse public transit and lack of affordable housing, increasing costs for agencies providing transportation and shelter.

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.

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

Somerset County Jail's extended-release buprenorphine program results in higher treatment retention and no overdose deaths post-release, compared to daily medication models.

Explores linkage facilitation for OUD at every touchpoint in the criminal legal system, using the Sequential Intercept Model to describe redirection to recovery-oriented care.

Utah's Intermountain Health team discusses jail-based programs that reduce recidivism and opioid deaths, and share strategies for community engagement and program replication.

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

Webinar highlights rural leadership and behavioral health directors roles in building sustainable, accessible behavioral health systems through community dialogue and policy.

This webinar explores stigma in rural communities and provide resources to support mental health in rural areas.

Carbon, Grand, and Emery counties in Utah have opioid death rates more than double the state average; this series investigates the crisis and potential solutions through interviews with affected individuals and officials.

Project CARA in Asheville, NC, provides integrated medical, substance use, and behavioral health care for pregnant and parenting people with SUD, aiming to reduce stigma and improve outcomes.

Discusses implementation and sustainability of NaloxBox programs for naloxone distribution in rural Wisconsin counties and schools.

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.

To support justice-involved individuals with substance use disorders in rural Nevada, the Office of the Attorney General has developed two outreach programs-Mobile Outreach Safety Teams (MOST) and Forensic Assessment Service Triage Teams (FASTT)-to intervene at various stages of the criminal justice process. Dr. Kerns, Dr. Snider, and DJ discuss how these teams operate, their impact at state and local levels, and strategies for overcoming implementation challenges.

Community Violence Intervention (CVI) is being adapted for rural America, with practitioners sharing insights on rural-specific approaches and challenges.

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.

Webinar shares lessons from county officials in the Reaching Rural Initiative on leadership and innovation to improve rural substance use outcomes.

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.

Mobile opioid treatment clinics bring medication-assisted treatment closer to rural residents, reducing travel burdens and improving access.

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.

Article explores challenges and strategies for implementing the 988 crisis line in rural areas, including Alabama and Mississippi, to improve mental health crisis response.

Rural cities use arts and civic engagement to address mental health, raise awareness, and foster creative solutions to local challenges.

The Principles for the Use of Funds From the Opioid Litigation are nationally recognized guidance for states, counties and cities receiving money from the lawsuits against entities that contributed to the opioid epidemic. Coordinated by faculty at the Johns Hopkins Bloomberg School of Public Health (Johns Hopkins), the Principles are designed to help governments of all levels lay the foundation to effectively invest opioid settlement funds to save lives from overdose.

A suicide/overdose fatality review (S/OFR) can impact community change and policies. Having the right participants at the S/OFR is critical to positive community engagement. Bringing together cross-sectors of a rural community to create change can bring remarkable success and significant challenges! Protecting our children and future community leaders is a great reason to work toward a solution and put bias aside. In 2019, the Jay County, Indiana, community developed an S/OFR. In 2020, it reviewed its first decedent.

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. 

Want to know how jurisdictions should prioritize programs for funding from the opioid litigation? This Primer on Spending Funds from the Opioid Litigation provides background information on each of the nine core abatement strategies including considerations for funding and implementation.

The “Funding Resources” section of A Guide to Funding Resources includes links to searchable databases offering funding opportunities from government and/or private sources available to local governments, community organizations, and individuals. It provides links to full text online guides and tips to assist grant writers prepare successful proposals. The reader may locate links to additional funding programs and information on the Rural Information Center (RIC) website. 

The goal of this series is to inform jurisdictions considering whether a mobile treatment program would work in their communities and to determine what type of model would fit best.  This article closes the series with some general takeaways and suggestions for law enforcement and public safety professionals who are interested in collaborating with a mobile treatment program in their community.

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.

The goal of this series is to inform jurisdictions considering whether a mobile treatment program would work in their communities and to determine what type of model would fit best.  The first program in this article is the Eastern Shore Mobile Care Collaborative (ESMCC) at Caroline County Health Department in Maryland. The second is the Mobile Health Services program implemented by the Colorado Department of Human Services, Office of Behavioral Health (OBH).

The goal of this series is to inform jurisdictions considering whether a mobile treatment program would work in their communities and to determine what type of model would fit best.  The two mobile models featured in this article are an induction-only program that prescribes Suboxone (buprenorphine/naloxone) and a methadone delivery program that was created because of the COVID-19 public health emergency.

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.

ONDCP has identified 26 overarching categories to organize this resource guide and help users identify potential sources of assistance for issues they find most challenging. This list is not exhaustive: many of the programs and resources listed in these pages cover a much broader range of potential uses.

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