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Opioid dispensing in the US dropped significantly between 2019 and 2025, with total opioid doses falling nearly 40% overall. But the progress isn't uniform — about 15% of counties actually saw opioid doses rise by 10% or more, and rural areas are driving that increase. The findings highlight a growing geographic divide in opioid prescribing patterns.
A new CDC-led study published in JAMA shows that opioid dispensing across the US fell sharply between 2019 and 2025, with total opioid doses dropping from 400.8 to 247.8 morphine milligram equivalents (MME) per person — a decline of about 7.6% per year. Overall prescription rates, high-dose prescriptions, long-duration prescriptions, and extended-release formulations all trended downward significantly.
But the national picture masks a troubling rural reality. While 76% of counties saw opioid doses drop by at least 10%, roughly 15% of counties — predominantly rural — saw doses increase by 10% or more. Rural counties made up nearly 62% of all areas with rising opioid dispensing rates, compared to just 8.3% of metropolitan counties.
By the Numbers:
Why it matters: The overall decline in opioid prescribing reflects years of public health efforts, but persistent rural hotspots signal that a one-size-fits-all approach won't close the gap. Targeted strategies for rural communities are essential to curbing ongoing opioid misuse risks.
