- Textor, Lauren;
- Friedman, Joseph;
- Bourgois, Philippe;
- Aronowitz, Shoshana;
- Simon, Caty;
- Jauffret-Roustide, Marie;
- Namirembe, Sarah;
- Brothers, Sarah;
- McNeil, Ryan;
- Knight, Kelly;
- Hansen, Helena
Rurality has served as a key concept in popular and scientific understandings of the US overdose crisis, with White, rural, and low-income areas thought to be most heavily affected. However, we observe that overdose trends have risen nearly uniformly across the urban-rural designations employed in most research, implying that their importance has likely been overstated or incorrectly conceptualized. Nevertheless, urbanicity/rurality does serve as a key axis to understand inequalities in overdose mortality when assessed with more nuanced modalities-employing a more granular analysis of geography at the sub-county level, and intersecting rurality sociodemographic indices such as race/ethnicity. Using national overdose data from 1999-2021, we illustrate the intersectional importance of rurality for overdose surveillance. Finally, we offer recommendations for integrating these insights into drug overdose surveillance moving forward.