Rural and urban Americans are getting the same opioid addiction medication through different doors, and the gap has practical consequences for who can start treatment and when. New federal surveillance data published in the Morbidity and Mortality Weekly Report show buprenorphine reaching rural patients mainly through retail pharmacies, while emergency departments have become an increasingly important entry point in cities.
The numbers are stark at the emergency room door. Adoption of buprenorphine, defined as administering it to at least one person during each month an opioid use disorder or overdose visit occurred, rose from 6.7 percent to 31.4 percent in urban counties between 2019 and 2025. In rural counties, it rose from 2.3 percent to 10.3 percent. By 2025, only about one in 10 rural emergency departments in the sample had adopted the practice.
