Substance use disorders, which afflict nearly 8% of the U.S. population,' exact a devastating human and economic toll. The opioid epidemic has caused overdose deaths to quadruple since 1999.2 In 2013 alone, the epidemic imposed an economic burden of over $78.5 billion, including $28.9 billion in spending on health care and substance abuse treatment. These burdens increasingly fall on rural and under-resourced areas, particularly in the Appalachian region. The crisis has evoked a range of policy reforms to prevent addiction, investments in treatment for sufferers, and lawsuits against purveyors of addictive substances.