Dispensing of buprenorphine — the first medication to treat opioid use disorder that can be prescribed in physician offices — through retail pharmacies remained higher in rural counties than in urban counties from 2019 to 2025, while emergency department adoption and administration remained lower in rural areas, according to an Aug. 27 CDC report.
The report examined trends in buprenorphine dispensing, treatment initiation and retention, pharmacy availability and ED administration in urban and rural counties from 2019 to 2025.
Researchers used IQVIA data on pharmacy-dispensed buprenorphine and the Premier Healthcare Database for ED-administered buprenorphine. IQVIA includes approximately 94% of U.S. retail pharmacy prescriptions, while the Premier Healthcare Database includes approximately 8 million inpatient admissions and 86 million outpatient visits annually from approximately 1,400 hospitals.
Here are seven things to know:
1. Buprenorphine dispensing increased through 2021 before declining through 2025. Dispensing rates remained higher in rural counties than in urban counties throughout the study period. In 2025, the rate was 51.1 per 1,000 persons in rural counties and 42.9 per 1,000 persons in urban counties.
2. Pharmacy availability increased in both rural and urban counties. From 2019 to 2025, availability increased from 64.9% to 80.0% in rural counties and from 64.8% to 72.4% in urban counties.
3. The number of buprenorphine prescribers increased while the number of patients per prescriber fell. From 2019 to 2025, prescribers per 1,000 persons increased from 0.1 to 0.4 in urban counties and from 0.1 to 0.2 in rural counties. Patients per prescriber declined from 48.7 to 25.7 in urban counties and from 60.1 to 36.3 in rural counties.
4. Treatment initiation and retention were higher in rural counties. Median monthly initiation rates were 14.2 per 100,000 persons in rural counties and 11.8 per 100,000 persons in urban counties. Median 180-day retention rates were 23.1% and 17.7%, respectively.
5. ED adoption of buprenorphine increased substantially but remained lower in rural counties. ED adoption increased from 6.7% to 31.4% in urban counties and from 2.3% to 10.3% in rural counties from 2019 to 2025.
6. Buprenorphine administration increased among ED patients with opioid use disorder or nonfatal opioid overdose. Rates increased from 33.9 to 111.1 per 1,000 visits in urban counties and from 25.2 to 103.3 in rural counties.
7. The findings point to different treatment pathways in rural and urban areas. Pharmacy dispensing, initiation and retention were higher in rural counties, while the number of prescribers relative to population and rates of ED-administered buprenorphine were higher in urban counties. The researchers said opportunities include strengthening pharmacy availability, supporting ED-based treatment and sustaining telehealth flexibilities.
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