CDC: More Drug Overdose Deaths in Cities Than in Rural Areas


The opioid epidemic has become widespread throughout the country, and it is considered a top public health priority.

The opioid epidemic has become widespread throughout the country and is considered a top public health priority. According to the CDC, 130 Americans die every day from an opioid overdose.1

Pharmacists can play an important role in educating the community on prescription drug abuse prevention strategies.

The CDC’s National Center for Health Statistics examined drug overdose death rates in the United States using the most recent data from the National Vital Statistics System (NVSS).2 The NVSS data included urban and rural differences in drug overdose death rates by sex, age group, and specific drugs involved. The report revealed that in 2016 and 2017, age-adjusted rates of drug overdose deaths were higher in urban (20 per 100,000 in 2016, and 22 in 2017) than in rural (18.7 in 2016, and 20 in 2017) counties.2 This is a change from previous years where drug overdose deaths occurred more in rural areas.

Other findings include that drug overdose rates in 2017 for males were higher in urban than rural counties (29.9 and 24.3, respectively), while for females the rates were higher in rural than urban areas (15.5 and 14.2, respectively).2 Drug overdose death rates were higher in urban areas for most age groups in 2017.

The types of drugs involved in the overdoses varied between urban and rural counties in 2017. The rates of drug overdose deaths involving heroin, synthetic opioids other than methadone (e.g. fentanyl, fentanyl analogs, and tramadol), and cocaine were higher in urban than rural counties. However, those involving natural and semisynthetic opioids and psychostimulants with abuse potential (e.g. methamphetamine, amphetamine, and methylphenidate) were higher in rural than urban counties.2

This report provides important information about the growing opioid epidemic and the importance of education and appropriate pain management. Limitations of the report include that toxicology tests may vary by county, which could affect the drug specific death rates.2 Also, drug overdose deaths may involve multiple drugs, causing a single death to be included in multiple categories.2

Pharmacists can educate patients and other health care professionals about the opioid antagonist naloxone, which can help prevent drug overdose deaths involving opioids. Many states also give pharmacists the authority to dispense naloxone through a standing order, statewide protocol, or without a prescription, increasing the availability of this lifesaving medication to have on hand.3


  • CDC. Opioid overdose: understanding the epidemic. CDC website. Last reviewed December 19, 2018. Accessed August 2, 2019.
  • CDC. Hedegaard H, Minino AM, Warner M. Urban-rural differences in drug overdose death rates, by sex, age, and type of drugs involved, 2017. NCHS Data Brief No. 345, August 2019. CDC website. Last reviewed August 2, 2019. Accessed August 2, 2019.
  • Naloxone access in community pharmacies. National Alliance of State Pharmacy Associations website. Published January 17, 2019. Accessed August 3, 2019.

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