Despite declines in prescription opioid overdoses, rural areas continue to have higher prescription opioid overdose rates than urban areas. We aim to understand high overdose places were resilient to the prescription opioid overdose crisis (better than predicted), while others were vulnerable (worse than predicted). First, we predicted prescription opioid overdose mortality in 2016–18 for N = 2,013 non-metropolitan counties using multivariable regression accounting. Second, we constructed a resiliency-vulnerability typology using observed, predicted, and residual values from the regression. Third, we selected a high-overdose resilient and vulnerable community for case study analysis using interviews, focus groups, and observations. High-overdose resilient and vulnerable places had disability-dispensing-overdose pathways, legacies of mining, and polysubstance drug abuse. Resilient places were larger population micropolitans with extensive health and social services, norms of redemption and acceptance of addiction, and community-wide mobilization of public and non-profit resources. Vulnerable places were smaller, more remote, lacked services, and stigmatized addiction.

尽管处方阿片类药物过量服用有所减少，但农村地区的处方阿片类药物过量服用率仍然高于城市地区。我们的目标是了解高过量地区对处方阿片类药物过量危机具有弹性（好于预期），而其他地区则很脆弱（比预期更糟）。首先，我们预测了 2016-18 年N的处方阿片类药物过量死亡率 = 2,013 个非大都市县使用多变量回归核算。其次，我们使用回归的观察值、预测值和残差值构建了弹性漏洞类型。第三，我们使用访谈、焦点小组和观察选择了一个高药物过量弹性和脆弱社区进行案例研究分析。高剂量恢复力和脆弱的地方有残疾配药过量途径、采矿遗留物和多种物质药物滥用。有弹性的地方是人口较多的小城市，拥有广泛的卫生和社会服务、救赎和接受成瘾的规范以及公共和非营利资源在社区范围内的动员。易受伤害的地方更小、更偏远、缺乏服务和成瘾问题。