800-671-430410% of Rural ERs Adopted Buprenorphine Treatment by 2025
Published: 09/3/2026
New CDC surveillance numbers show that medication-assisted treatment for opioid use disorder has become more available in some ways over the past six years. It also showed it remained less available in other ways. The trend is more nuanced than a simple increase or decrease in availability.
Writing in the August 27 Morbidity and Mortality Weekly Report, CDC researchers tracked buprenorphine dispensing, treatment initiation and retention, pharmacy stocking and emergency department administration. The analysis covered 2019 to 2025 across urban and rural counties.
By 2025, only 10.3 percent of rural emergency departments had adopted buprenorphine treatment. In urban counties the figure was 31.4 percent.
Both are up sharply from 2019. At the time, rural adoption sat at 2.3 percent and urban at 6.7 percent. Both still mean the majority of emergency departments are not offering the medication.
Why Medication Assisted Treatment Matters at the Point of Overdose
Deaths that involved opioids accounted for 54,045 of all US overdose deaths in 2024. An estimated 4.8 million people had a diagnosed opioid use disorder. Roughly one in four of them receives any medication for the condition.
An emergency department visit after a nonfatal overdose could be one of the few times a person with untreated opioid use disorder is already in front of a clinician.
Starting buprenorphine before discharge rather than handing over a referral is what converts that visit into treatment. The CDC authors noted that low ED adoption “suggests missed opportunities for treatment and persistent implementation barriers.”
Where emergency departments did administer it they administered it far more often. Among ED visits for opioid use disorder or nonfatal overdose the buprenorphine administration rate rose from 33.9 to 111.1 per 1,000 visits in urban counties and from 25.2 to 103.3 in rural counties.
Understanding Buprenorphine
Buprenorphine is a partial opioid agonist approved by the FDA to treat opioid use disorder. It eases withdrawal and cravings without causing the high of other opioids and lowers the risk of slowed breathing and overdose.
In withdrawal management it does two jobs. It eases the worst of withdrawal and can then continue as long-term treatment that lowers the risk of mortality.
Buprenorphine is not a detox medication that gets tapered off as a matter of course. Treatment length should be tailored to each person and sustained engagement leads to better outcomes.
Dispensing Peaked in 2021 and Has Fallen Since
The authors link this to growing recognition that people exposed to fentanyl may need higher doses. They also link this to the 2024 clarification by the FDA that buprenorphine labeling specifies no maximum dose.
Who Stays in Treatment
Rural counties outperformed urban ones on both initiation and retention. Median monthly initiation was 14.2 per 100,000 persons in rural counties against 11.8 in urban counties. Retention over 180 continuous days reached 23.1 percent in rural counties and 17.7 percent in urban counties.
Retention under 25 percent in the better-performing group is the number worth sitting with. It means roughly three in four people who start buprenorphine are not still on it six months later. The CDC data show retention declining over time in both settings.
More clinicians are prescribing since the federal waiver requirement was eliminated in December 2022. Prescribers per 1,000 persons rose from 0.1 to 0.4 in urban counties and 0.1 to 0.2 in rural counties while caseloads per prescriber fell by roughly half.
Prescribing still concentrates heavily among high-volume clinicians who accounted for 84.8 percent of urban prescriptions and 81.0 percent of rural prescriptions by 2025.
Pharmacy stocking improved as well. The share of pharmacies dispensing buprenorphine consistently rose from 64.8 to 72.4 percent in urban counties and from 64.9 to 80.0 percent in rural counties.
Finding Medical Detox and Buprenorphine Treatment
For readers acting on this data a few concrete steps. Ask whether the program starts and continues buprenorphine or tapers it before discharge.
Ask whether telehealth follow-up is available since the CDC authors specifically flag sustaining telehealth flexibilities as a rural access lever. Ask how the plan goes for the first 180 days given what the retention numbers show.
If you are in a rural area calling ahead to confirm a pharmacy stocks buprenorphine before filling a first prescription remains worth doing even with stocking rates improved.
Detox.com’s directory lists medically supervised detox programs. It provides details on substances treated levels of care MAT availability and insurance accepted. Call 800-996-6135 to get in contact with a treatment specialist today.
