Substance use disorder treatment and technology access among people who use drugs in rural areas of the United States: A cross-sectional survey

J Rural Health. 2023 Sep;39(4):772-779. doi: 10.1111/jrh.12737. Epub 2022 Dec 27.


Purpose: To evaluate how technology access affected substance use disorder (SUD) treatment prior to COVID-19 for people who use drugs in rural areas.

Methods: The Rural Opioid Initiative (January 2018-March 2020) was a cross-sectional study of people with prior 30-day injection drug or nonprescribed opioid use from rural areas of 10 states. Using multivariable mixed-effect regression models, we examined associations between participant technology access and SUD treatment.

Findings: Of 3,026 participants, 71% used heroin and 76% used methamphetamine. Thirty-five percent had no cell phone and 10% had no prior 30-day internet use. Having both a cell phone and the internet was associated with increased days of medication for opioid use disorder (MOUD) use (aIRR 1.29 [95% CI 1.11-1.52]) and a higher likelihood of SUD counseling in the prior 30 days (aOR 1.28 [95% CI 1.05-1.57]). Lack of cell phone was associated with decreased days of MOUD (aIRR 0.77 [95% CI 0.66-0.91]) and a lower likelihood of prior 30-day SUD counseling (aOR 0.77 [95% CI 0.62-0.94]).

Conclusions: Expanding US rural SUD treatment engagement via telemedicine may require increased cell phone and mobile network access.

Keywords: addiction; opioids; rural health; telemedicine.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Analgesics, Opioid
  • COVID-19* / epidemiology
  • Cross-Sectional Studies
  • Humans
  • Methamphetamine*
  • Opioid-Related Disorders* / drug therapy
  • Opioid-Related Disorders* / epidemiology
  • United States / epidemiology


  • Analgesics, Opioid
  • Methamphetamine