Explainer Series Intro: Rural Communities Need Harm Reduction, Too

Overdose deaths in the United States have claimed more than 100,000 lives annually in recent years. While the vast majority of these fatalities occur in metropolitan areas, rural communities are affected as well. In fact, in 24 states, the rate of overdose mortality—that is, how many people die per 100,000 population—in rural counties is either similar to or higher than it is in urban counties. As such, although harm reduction was largely developed by and for people living in cities, this lifesaving approach is just as important in the country’s dispersed and geographically isolated settings as it is in New York or San Francisco.

However, despite the fact that approximately 97 percent of the United States is classified as rural, these remote areas are home to only about a quarter of the nation’s syringe services programs. Nonetheless, harm reduction does work in rural settings. Evidence suggests that well-established interventions that were developed in urban centers also reduce infectious disease transmission, overdose risk, and more in rural areas. Furthermore, harm reduction is at its best in terms of both efficacy and cost-effectiveness when it is tailored to specific community needs, an approach that aligns well with the concept of limited but effective governance.

With limited governance and cost-effectiveness in mind, lawmakers serving rural areas would do well to authorize expanded harm reduction in their jurisdictions. In addition, to optimize impact, laws should provide organizations with the flexibility to adapt in real time and shape programming to meet local circumstances and needs.  

This diversity of evidence-based harm reduction programming in rural communities is part of why the R Street Institute consistently urges policymakers to avoid being overly prescriptive in their harm reduction legislation. The best policy in this area encourages the use of well-established practices while leaving room for adaptation to changing drug supplies and drug use behaviors. Rural communities across the country have harnessed harm reduction in ways that epitomize this combination of pragmatism and innovation to help keep their residents as safe and healthy as possible.

This explainer series will highlight the potential of rural harm reduction and policies that facilitate it by showcasing innovative, tailored interventions from organizations serving a variety of rural areas.

Part 1: Rural Harm Reduction: Spotlight on Edgecombe County, North Carolina

Part 2: Rural Harm Reduction: Spotlight on Cochise County, Arizona