Urban vs. Rural Youth Substance Abuse—What’s the Difference?

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When you think of the epicenter of a drug trade, skyscrapers, traffic, and bustling cities may come to mind.

But research shows drug use may be just as high—or even higher—in less populated towns across America. In fact, among the many factors that increase likelihood of substance abuse, living in a rural area is one of them.

Are there differences in urban and rural drug use, and what are they? Let’s take a closer look.

Opioid Use May Be Higher in Rural Areas

Alcohol, tobacco, and drug use are prevalent in both urban and rural communities. But when it comes to small, remote towns, one substance ranks higher in abundance when compared to larger cities—opioids.

Multiple studies have shown opioid use may be higher in rural areas than in urban communities. From 2010 to 2017, according to the Agency for Healthcare Research and Quality (AHRQ), the national rate of opioid-related inpatient hospital stays increased by more than 76 percent in rural locations (1). The data also show emergency department visits related to opioid abuse increased by more than 95 percent in the same time frame.

But what’s driving the high percentages of opioid abuse in rural areas? Experts believe it’s a combination of socioeconomic factors combined with chances of receiving an opioid prescription. In small communities like those in West Virginia, the Centers for Disease Control and Prevention discovered the most rural counties had an 87 percent higher chance of receiving a script for opioids compared with those in large central metropolitan counties (2). This means if you’re located in a small, rural town, there may be higher accessibility to dangerous opioids with a quick trip to a doctor’s office.

Drug Use May Start Earlier in Rural Areas

Not only is opioid use potentially more prevalent in rural areas, but it may also start in younger ages. One study looking at drug use among teens in rural Kentucky versus a metropolitan area of the state shows those living in the rural county had significantly earlier ages of use of opioids like oxycodone, hydrocodone, and benzodiazepine (3).

Other studies confirm the same findings. In fact, 2020 research from the United States Department of Agriculture shows young people aged 15-24 experienced the greatest percentage increase in opioid-related deaths (4). Researchers cite several factors for youth opioid abuse in rural areas, including:

  • Geographic isolation from education and support
  • Lack of parental influence or supervision
  • Increased access to opioids at home or in social circles
  • Past or current history of drug abuse within the home

Illicit Drugs Play a Major Role in Opioid Deaths in Rural Communities

Illicitly manufactured synthetic opioids are on the rise and contributing to overdoses and deaths at startling rates.

Fentanyl, for example, is a drug nearly 100 times more potent than morphine. While it’s used under careful medical supervision to treat pain in health settings, fentanyl is also manufactured illegally and mixed in with other illicit drugs to increase potency.

According to the United States Drug Enforcement Administration, drug traffickers typically distribute fentanyl by the kilogram—with just one kilogram of fentanyl having the potential to kill 500,000 people (5). DEA analysis reveals 42 percent of pills tested contained at least 2 mg of fentanyl, an amount considered a lethal dose.

This means in an area where youth drug use is on the rise, there’s no telling what’s in pills that have been illegally obtained. Children and teens could very well engage in opioid use without knowing if it contains fentanyl. And it’s the main reason why synthetic opioids like fentanyl are the main driver of overdose deaths in the United States.

There is Hope for Rural West Virginia Communities Suffering from Addiction

If you live in West Virginia, there’s a high chance you know or have been acquainted with someone touched by addiction, especially opioid-related substance abuse. As more data is released, it’s clear that some of the highest rates of addiction are in rural areas that lack the resources, infrastructure, education, and support for individuals dependent on drugs—at least, until now.

Movements like GameChanger are committed to starting the conversation right in West Virginia schools, empowering youths with knowledge before addiction starts.

About GameChanger

Created in 2018, GameChanger is a student-powered movement with focus on substance misuse prevention among youths. We connect students, educators, and communities with education, training, coaching, and support services to prevent opioid and other drug use before it starts.

Visit our resources to learn more.


1. HCUP FAST STATS – OPIOID-RELATED HOSPITAL USE. Agency for Healthcare Research and Quality. Accessed from: https://www.hcup-us.ahrq.gov/faststats/OpioidUseServlet?location1=US&characteristic1=05&setting1=IP&location2=US&characteristic2=05&setting2=ED&expansionInfoState=hide&dataTablesState=hide&definitionsState=hide&exportState=hide

2. More Opioids Being Prescribed in Rural America. American Academy of Family Physicians. 28 January 2019. Accessed from: https://www.aafp.org/news/health-of-the-public/20190128ruralopioids.html

3. Young AM, Havens JR, Leukefeld CG. A comparison of rural and urban nonmedical prescription opioid users’ lifetime and recent drug use. Am J Drug Alcohol Abuse. 2012 May;38(3):220-7. doi: 10.3109/00952990.2011.643971. Epub 2012 Jan 3. PMID: 22211586.

4. Opioid Misuse in Rural America. United States Department of Agriculture. Accessed from: https://www.usda.gov/topics/opioids

5. United States Drug Enforcement Administration. Facts about Fentanyl. Accessed from: https://www.dea.gov/resources/facts-about-fentanyl

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