Opioid abuse is the fastest growing substance abuse problem in the nation and the primary cause of unintentional drug overdose deaths. In recent years, non-medical use of pain relievers has been higher in urban counties than rural, however, multiple studies document a higher prevalence rate among specific vulnerable rural populations, particularly among youth, women who are pregnant or experiencing partner violence, and persons with co-occurring disorders. Heroin use has also grown significantly in recent years, particularly among those reporting non-medical use of opioid pain relievers prior to initiating heroin.

This study examined the rural-urban prevalence of non-medical use of pain relievers and heroin in the past year and the socioeconomic characteristics associated with their use as well as treatment history and perceived need for treatment; perceived risk of using drugs; and other risky behavior. Rural opioid users were more likely to have socioeconomic vulnerabilities that might put them at risk of adverse outcomes, including limited educational attainment, poor health status, being uninsured, and low-income. Rural heroin users—especially men and those in poor health—were less likely than urban to say there was a great risk in trying heroin only once or twice.

Key Findings:

• Although the prevalence of non-medical pain reliever and heroin use in the past year was slightly higher among urban persons than rural, the magnitude of the difference was small.
• Rural opioid users were more likely to have socioeconomic vulnerabilities that might put them at risk of adverse outcomes, including limited educational attainment, poor health status, being uninsured, and low-income.
• Rural heroin users — especially men and those in poor health — were less likely than urban to say there was a great risk in trying heroin only once or twice.
• Compared to urban, rural opioid users were more likely to have ever been arrested and booked for breaking the law and to have been on probation in the past year.