A Systematic Review of Prevention Approaches to Rural Opioid Use

Background and Purpose: Opioid use is pervasive in rural communities and has impacted the health and welfare of rural people. The opioid epidemic has hit these communities the hardest. Recent studies documenting the number of opioid overdoses across the country suggest that prevention efforts might have an impact in mitigating the adverse effects of opioid misuse on individual health and opioid-related economic tolls. Nationwide opioid use prevention efforts and strategies are not well understood, particularly in rural areas. This makes it difficult for service providers and policymakers to make informed decisions in developing or selecting effective preventive strategies to fight the current opioid epidemic. Many of the programs that have been developed to prevent opioid misuse in urban settings may not fit easily within rural areas. For these reasons, it is important to systematically examine the current scientific knowledge about opioid misuse prevention programs in rural areas.

Methods: Using PRISMA guidelines, prevention literature specific to rural opioid misuse was assessed from June-August 2019 by an independent reviewer at three levels: universal (n=3), selected (n=5), and indicated (n=5). These classification types were nested in two levels of prevention ecology: micro and macro. Following comprehensive literature searches, titles and abstracts were reviewed to determine if articles met the inclusion criteria. These articles were stored in an electronic database accessible only by the research team. Full texts were then reviewed to determine final eligibility for inclusion.

Results: Using the Institute of Medicine’s (IOM, 1994) program classifications systems, this review found three universal, five selective, and five indicated prevention articles regarding rural opioid use. Of those regarding universal prevention approaches, one was micro-focused and two were macro-focused. The search for selective prevention approaches resulted in three micro-focused approaches and two macro-focused approaches. Finally, the indicated prevention approaches were overwhelmingly micro-focused (four micro, one macro). Prevention efforts were found to be largely effective; however, programs are scarcely tailored to the individual needs of rural areas. The literature focuses on selected and indicated prevention, with relatively little information on universal prevention. Likely due to the rapid progression of the opioid epidemic, prevention efforts have been largely reactive.

Conclusions and implications: This review suggests rural opioid use prevention approaches must be more comprehensive and tailored to the needs of rural communities. To prevent future crises such as this one and support rural communities in the midst of this epidemic, it is crucial to allot resources and energy to universal prevention. These three areas of prevention must all be capitalized on to most effectively address the past, current, and future consequences of this epidemic.