The investigators then dug into the data on those individuals who had used prescription opioids. They determined how many survey participants misused prescription opioids but had not (at least not yet) developed a serious enough problem to warrant a medical diagnosis of opioid user disorder, as well as how many were misusing opioids and experiencing sufficient harm and signs of addiction to meet such diagnostic criteria. Opioid misuse without a diagnosis of disorder was not concentrated in rural areas. In fact the rate was, if anything, slightly higher (11.3 percent) in big cities than in nonmetropolitan areas (9.0 percent). The prevalence of opioid use disorder also varied little across geographic areas.
These findings don’t erase the fact that rural areas face unique challenges regarding prescription opioids. Outside urban areas, health-care professionals who can treat addicted patients are in short supply and first responders to overdose emergencies, when every second counts, often have significant distances to travel. That said, it is no longer appropriate to describe prescription opioid addiction as a rural phenomenon, because it has spread throughout cities, suburbs and towns. What was once a rural epidemic is now a national one.