Rural drug OD death rates fell below urban rates recently, but meth ODs are nearly one and a half times higher

Rural-urban differences in age-adjusted drug overdose deaths by jurisdiction of residence in 2019
Centers for Disease Control and Prevention map; click the image to enlarge it

Drug overdose death rates skyrocketed in the U.S. in the past 20 years. Though overall age-adjusted rural rates fell below urban rates recently, driven by a reduction in opioid deaths, rural overdose deaths from methamphetamines and other psychostimulants remained much higher, according to a study newly published by the Centers for Disease Control and Prevention.

From 1999 through 2019, the drug overdose death rate rose from 6.4 per 100,000 to 22 in urban counties and from 4 to 19.6 in rural counties. However, in 2019 rates in rural counties were higher than urban counties in California, Connecticut, North Carolina, Vermont, and Virginia, the study says. 

Death rates from natural and semisynthetic opioids (such as oxycodone, hydrocodone and codeine) were higher in rural counties from 2004 through 2017 but were similar in 2018 and 2019, the CDC reports. Death rates from synthetic opioids such as fentanyl followed a similar pattern: From 2001 through 2014, death rates were higher in rural counties, but from 2015 through 2019, rural rates were lower than urban counties. Death rates from heroin were higher in urban counties from 1999 through 2019.

However, drug overdose death rates involving psychostimulants remained higher in rural counties from 2012 through 2019, and by 2019 the rate in rural counties was nearly one and a half times higher than in urban counties, the report says. Cocaine overdose deaths remained higher in urban counties from 1999 through 2019.