Buprenorphine access patterns differ between rural and urban U.S. counties

The report used data from IQVIA on buprenorphine dispensed by pharmacies and from the Premier Healthcare Database on emergency-department care. It examined U.S. trends from 2019 through 2025, comparing counties classified as urban or rural.

Buprenorphine is approved by the Food and Drug Administration to treat opioid use disorder. The report notes that the medicine can reduce overdose risk and deaths, but says it remains underused and that many people who could benefit lack access.

Researchers looked at several parts of access and treatment: pharmacy dispensing, treatment initiation among people newly receiving buprenorphine, treatment retention, pharmacy availability, and emergency-department administration. The supplied abstract does not provide the number of people, pharmacies, hospitals, or counties included, nor does it give exact rates or the definition used for urban and rural counties.

Dispensing rates increased from 2019 to 2021, then declined afterward. Across the full study period, pharmacy dispensing rates were consistently higher in rural counties than in urban counties. The number of patients per prescriber and prescriptions per prescriber declined in both types of counties.

The report also found that treatment initiation and retention were higher in rural counties. However, initiation declined in urban counties, and retention declined over time in both rural and urban areas. Because this is a trend report, the findings cannot show why these changes happened or whether they reflect differences in need, availability, insurance, local services, or other factors.

Pharmacy availability of buprenorphine increased in both rural and urban counties. Emergency departments also increasingly adopted and administered buprenorphine in both settings. Still, emergency-department adoption and administration remained lower in rural counties, while the report describes rural areas as relying more on pharmacy dispensing.

The authors point to possible ways to improve access, including making prescriptions easier to start, strengthening pharmacy availability, supporting emergency-department treatment in rural areas, and maintaining telehealth flexibilities. These are policy implications from the findings, not proof from this report that any one approach will improve treatment or overdose outcomes.

The report offers a broad picture of differences in how buprenorphine was provided across places over time. More research would be needed to explain the gaps, assess care quality, and determine whether changes in access lead to better health outcomes.