What are the top substance abuse issues in urban and rural areas?

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Top Substance Abuse Issues in Urban and Rural Areas

Alcohol use disorder is the most common substance use disorder across both urban and rural settings, followed by marijuana, with opioids causing the highest mortality burden despite lower prevalence. 1

Overall Substance Use Patterns

Urban Areas (Large Metropolitan)

  • Highest overall illicit drug use prevalence compared to smaller metropolitan and rural areas throughout 2003-2014 2
  • Marijuana remains the most abused illicit substance after alcohol, with 22.2 million current users nationally 1
  • Prescription pain relievers rank second among illicit drugs, with 4.3 million reporting current nonmedical use 1
  • Cocaine ranks third in prevalence among urban substance users 1

Rural Areas (Nonmetropolitan)

  • Alcohol and methamphetamine use rates exceed urban areas among youth and young adults 3
  • The more rural the area, the higher the alcohol and methamphetamine use among youth aged 12-17 years 3
  • Rural young adults in rural-large areas have nearly twice the methamphetamine use rate compared to urban young adults 3
  • Drug overdose death rates in rural areas (17.0 per 100,000) surpassed urban rates (16.2 per 100,000) by 2015, despite urban areas having lower rates historically 2

Critical Mortality and Morbidity Considerations

Opioid Crisis Impact

Opioids cause the highest mortality burden despite not being the most prevalent substance used. 1

  • 28,647 deaths were associated with opioids in 2014, exceeding automobile crash deaths 1
  • Drug overdose death rates increased 137% overall, with a 200% increase specifically for opioid overdoses since 2000 1
  • Hospitalizations for opioid use disorder rose from 302,000 to over 520,000 between 2002-2012, with costs quadrupling to $15 billion 1

Polysubstance Use Patterns

Individuals using both opioids and methamphetamine have significantly worse health outcomes than those using either substance alone 4

  • 132% higher prevalence of injection needle use when both substances are used together 4
  • Nearly twofold higher prevalence of viral hepatitis with combined opioid-methamphetamine use 4
  • One-third have severe mental illness, representing 55% higher prevalence than opioid use alone 4
  • People using methamphetamine are more likely to be unstably housed, low-income, and live in rural areas 4

Prevalence by Substance Type

Alcohol Use Disorder

  • 17.3 million people had alcohol dependence or abuse in 2013, making it the most common substance use disorder requiring treatment 1
  • 14.7 million had alcohol dependence/abuse without illicit drugs 1

Marijuana/Cannabis

  • 22.2 million current users as of 2014 1
  • Rising use rates driven primarily by marijuana, with 2014 rates higher than any year from 2002-2013 1

Prescription Opioids and Heroin

  • 4.3 million report current nonmedical use of prescription pain medication 1
  • Heroin use has nearly doubled since 2006 as a consequence of prescription opioid restrictions 1

Methamphetamine

  • Disproportionately affects rural populations, particularly youth and young adults 3
  • Rural youth have higher methamphetamine use than urban youth, with rates increasing with rurality 3

Cocaine

  • Third most common illicit substance after marijuana and prescription pain relievers 1

Geographic-Specific Risk Factors

Urban-Specific Concerns

  • Higher absolute numbers of overdose deaths (45,059 metropolitan vs 7,345 nonmetropolitan in 2015) 2
  • Greater access to multiple drug types contributing to polysubstance use 2

Rural-Specific Concerns

  • Higher rates of driving under the influence of alcohol or illicit drugs among rural youth 3
  • Limited treatment infrastructure despite rising overdose death rates 2
  • Methamphetamine epidemic particularly severe in rural areas 3, 4

Treatment Gap

Only 18% of the 22.5 million people needing substance use disorder treatment received any form of treatment in 2014, with approximately 10% receiving specialty facility treatment 1. This treatment rate is far below that for hypertension (77%), diabetes (73%), or major depression (71%) 1.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Research

Illicit Drug Use, Illicit Drug Use Disorders, and Drug Overdose Deaths in Metropolitan and Nonmetropolitan Areas-United States.

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 2017

3
Research

Substance abuse by youth and young adults in rural America.

The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 2008

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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