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The United States is in the midst of an unprecedented crisis of prescription and illicit opioid misuse, use disorder, and overdose. In 2018, nearly 47,000 Americans died from an overdose involving opioids [174]. In 2018, 10.3 million people aged 12 years and older reported misusing prescription opioids or using heroin, and 2 million met the diagnostic criteria for having an opioid use disorder in the past year—lower than 2015 through 2017 [150].

Although the crisis has affected large swaths of the U.S. population, it has affected certain segments of the population with an extra level of intensity—justice-involved populations, rural populations, veterans, adolescents and young adults, and persons who inject drugs. Other than for persons who inject drugs, little research to date has been dedicated toward understanding the specific needs of these special populations, including building the evidence base for targeted approaches and solutions. Research has clearly shown that solutions for the opioid overdose epidemic are not one size fits all, and special attention should be paid to these populations that may be suffering unduly. For each identified population, this manuscript reviews why it is an important area of focus, current barriers encountered in accessing care, promising approaches in supporting this population, and high-impact research and action priorities.

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