Assessment of prescription opioid intentional exposures across the rural-urban continuum in the United States using both population and drug availability rates

Pharmacoepidemiol Drug Saf. 2014 Dec;23(12):1334-7. doi: 10.1002/pds.3653. Epub 2014 Jun 4.


Purpose: Prescription opioid abuse and misuse are a serious problem in the U.S. today. Several studies have shown that the epidemic disproportionately affects rural areas. This paper uses three different rates to gain a more complete picture of opioid abuse in rural areas.

Methods: This study examines prescription opioid intentional exposures using opioid classes tracked in the RADARS(®) System Poison Center Program. Intentional exposure rates were calculated adjusting for population and unique recipients of dispensed drug (URDD). These rates were analyzed using time (quarter) and the proportion of a three-digit zip code residing in a rural area as covariates. Additionally, the URDD per population rate was calculated to examine the proportion of the population filling prescriptions for opioids.

Results: After adjusting for population, intentional exposure cases significantly increased as the proportion of the population residing in a rural area increased. However, when adjusting for URDD, intentional exposure cases decreased with increasing rural population. The URDD per population increased as the proportion of people residing in a rural area increased.

Conclusions: Using both population and URDD adjusted intentional exposure rates gives a more complete picture of opioid abuse in rural areas. Considering product availability can be used to develop opioid abuse prevention strategies and further the education of physicians serving rural areas about this epidemic.

Keywords: URDD; intentional exposures; pharmacoepidemiology; poison center; population rates; prescription opioid; rural.

Publication types

  • Historical Article

MeSH terms

  • Adult
  • Analgesics, Opioid / administration & dosage*
  • Analgesics, Opioid / supply & distribution*
  • Female
  • History, 21st Century
  • Humans
  • Male
  • Rural Population / statistics & numerical data*
  • Substance-Related Disorders / epidemiology*
  • United States / epidemiology
  • Urban Population / statistics & numerical data


  • Analgesics, Opioid