Prevalence and Correlates for Nonmedical Use of Prescription Opioids Among Urban and Rural Residents

Although the prevalence and risk factors related to the nonmedical use of opioids are similar among rural and urban U.S. residents, there are differences in the drugs used, as well as notable demographic patterns.

Abuse of prescription drugs, i.e., the nonmedical use of prescription drugs, is a national problem. Prescription opioids are a significant element of that abuse in both rural and urban settings and have contributed to a greater increase in overdose deaths in the past decade among rural adults. But little has been known about the differences in this drug abuse within types of communities. Using data from the 2008-2009 National Survey on Drug Use and Health, this study examined the prevalence, drugs used, and correlates and differences of opiate drug abuse among urban and rural residents. There were 75,964 respondents, of whom 16.6 percent lived in rural counties.

Key Findings:

  • The prevalence of nonmedical opiate use was similar among urban (4.7%) and rural (4.3%) residents.
  • Both urban and rural abusers are more likely than their community peers to be younger, male, unmarried, uninsured, and have lower income. They are also more likely to report “severe psychological distress,” nonprescription use of other medications, and alcohol and nicotine use.
  • White urban dwellers were more likely than their Black and Hispanic peers to abuse prescription opioids.
  • Urban dwellers who first used illicit drugs between the ages of 18-25 and those who use alcohol are more likely to report nonmedical opioid use.
  • Rural residents are more likely to use acetaminophen with propoxyphene or with codeine, or methadone.

The authors believe their findings suggest prevention and treatment should be expanded in rural areas, and tailored to meet the specific needs of urban and rural communities. They also note that the use of acetaminophen and methadone, both potentially lethal drugs, may be contributing to the rise in drug-related deaths among rural residents.