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Key Points Question What are the characteristics of US counties with high rates of opioid overdose mortality and low capacity to deliver medications for opioid use disorder? Findings In this cross-sectional study of data from 3142 US counties, counties in the South Atlantic, Mountain, and East North Central divisions had more than twice the odds of being at high risk for opioid overdose mortality and lacking in capacity to deliver medications for opioid use disorder. Higher density of primary care clinicians, a younger population, micropolitan status, and lower rates of unemployment were associated with lower risk of opioid overdose and lower risk of lacking in capacity to deliver medications for opioid use disorder. Meaning Strategies to address mortality from opioid overdose by increasing treatment for addiction should target urban counties in Appalachia, the Midwest, and the Mountain division and include efforts to increase primary care clinicians and employment opportunities.

This article is part of a supplement entitled The Behavioral Health Workforce: Planning, Practice, and Preparation, which is sponsored by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration of the U.S. Department of Health and Human Services.