“The Opioid Crisis Is at its Worst in Rural Areas. Can Telemedicine Help?” by Jamey J. Lister 1 Some of the communities hit hardest by the opioid epidemic are in rural America. However, many of those same communities lack access to comprehensive treatment. 2 To address the epidemic’s increasing reach, the White House declared a public health emergency on Oct. 26. The administration outlined a need to expand treatment in rural communities, most notably by making telemedicine more readily available. Telemedicine, also referred to as telehealth, aims to improve treatment access by allowing people to consult their provider remotely – for example, by using videoconferencing. 3 As a researcher of opioid treatment in Michigan, I’m excited to see the call for greater availability of telemedicine as a way to help rural communities. However, telemedicine has important limitations that need to be considered. Rural struggles 4 Drug overdose deaths are rising in rural areas across the U.S. In 2015, the overdose death rate for rural areas surpassed the death rate for urban or suburban areas. People living in rural areas were four times more likely to die from overdoses in 2015 than they were in 1999. The opioid epidemic hit states east of the Mississippi River hardest, with the highest death rates in relatively rural states: West Virginia, New Hampshire and Kentucky. 5 The most scientifically supported opioid treatments combine medications – like buprenorphine, methadone or Suboxone – with behavioral therapy. These opioid treatment programs help patients stop abusing opioids and promote long-term recovery. 6 However, people living in rural areas face a number of barriers in accessing opioid treatment. Many rural populations have a limited number of clinics that provide opioid treatment and behavioral therapy, as well as a shortage of providers who prescribe opioid treatment medications. People living in rural areas frequently travel long distances to their opioid treatment provider. Moreover, many may feel ashamed or stigmatiz