Grand County, Utah Shows How Small Communities Can Build Comprehensive Recovery Systems

Grand County, Utah has emerged as a model for how small, rural communities can transform opioid settlement dollars into comprehensive recovery infrastructure. The southeastern Utah county—home to roughly 9,700 residents—has directed its share of national pharmaceutical settlements toward a three-pronged approach that combines clinical treatment, peer recovery coaching, and community-based wellness programs.

The results are measurable. According to the Utah Department of Health and Human Services, Grand County's overdose fatality rate has fallen from 31 deaths per 100,000 residents in 2023 to 20 in 2024 and just 10 in 2025—well below the statewide rate of 17 to 18 deaths per 100,000.

Building Recovery Infrastructure from Scratch

When county commissioners first allocated settlement funds in 2022, Grand County had limited options for people seeking help with substance use disorders. Today, three organizations work in concert to serve different stages of recovery, from initial treatment through long-term maintenance.

The Moab Regional Recovery Center anchors the clinical side. Opened in 2022 as the only full-service outpatient recovery center in southeastern Utah, the clinic provides medications for opioid and other substance use disorders, counseling, integrated primary and mental health care, and case management. Staff also help patients navigate practical barriers like housing and transportation while connecting them with other local resources.

"Almost on a daily basis, we have people come in and say they wouldn't be able to continue this care if we weren't able to offer financial assistance," said Clinic Director Doug Caylor. About one-third of the center's patients are uninsured or pay for care themselves.

The clinic recorded more than 3,300 patient visits last year—roughly 10% more than the year before—while treating 383 unique patients. Caylor, who has worked in Moab's medical community since 1996, said people seeking help for substance use disorders once had few options beyond the emergency room. The recovery center was created to fill that gap.

"We've easily doubled what we thought" in terms of patient volume, Caylor said. "I think everybody was surprised in the long run how big this clinic really has gotten and how much the need is out in the community."

Peer Support Inside and Outside Jail Walls

Utah Support Advocates for Recovery Awareness (USARA) receives the largest share of county settlement funding—about 60% of the annual allocation, or roughly $25,400 this year. Rather than providing medical treatment, peer recovery coaches help people work toward goals that support long-term recovery: finding housing, employment, and transportation; rebuilding family relationships; and connecting with community resources.

From April 2024 through March 2026, USARA provided more than 1,100 peer coaching sessions to 109 people, facilitated 444 recovery groups attended by more than 2,400 participants, and reached more than 8,400 people through community events.

USARA also partners with the Moab Regional Recovery Center inside the Grand County jail, where staff lead weekly recovery groups, provide individual peer coaching, and help people develop recovery plans before they return to the community. People leaving jail receive naloxone, fentanyl test strips, overdose prevention supplies, and information about local recovery resources.

"When I would get out of jail, I didn't have any resources," said Lanette Denton, USARA's Moab program manager, who is in long-term recovery herself. "Providing folks with a safety plan before they exit the jail and all of these resources gives them a space where they can do things differently."

Denton said recovery resources in Grand County have expanded significantly over the past several years. Where recovery once relied largely on the courts and compliance-based programs, residents today can choose from peer coaching, medications for opioid use disorder, outpatient treatment, and other approaches.

"There's multiple pathways to recovery now," Denton said. "There are so many different resources and options in our community now, so it's been amazing to be a part of that and see it grow."

Community Connection as Recovery Tool

The Wellness Collective rounds out Grand County's approach with community-based programs intended to complement clinical treatment and peer support. The organization receives about 20% of the county's annual opioid settlement allocation—roughly $8,500 this year—to support about 20 recovery-focused classes each month.

Programs include recovery yoga, trauma-informed yoga, community acupuncture, Recovery Dharma meetings, recovery hikes, and creative arts programming. According to the organization's funding application, the free classes help participants build healthy routines and supportive connections during recovery.

"I think community and connection are really the antidotes to addiction," said Executive Director Breann Davis. "There's no one path to recovery. It's so individualized for each person."

Recovery class participation has doubled over the past year, according to the organization's funding application. Davis attributed much of that growth to referrals from partner organizations and word of mouth as more people learn about the recovery resources available in Grand County.

Because the nonprofit relies on volunteers and contracted instructors rather than salaried staff, Davis said the funding goes directly toward programming. Looking back over more than a decade, she said local recovery resources have grown from a handful of support groups into a broader network of organizations serving different needs.

"When I first moved here 13 years ago, there really wasn't anything for recovery," Davis said. "There were like AA groups and things like that, but there wasn't anything like this."

A Model for Rural Communities

Grand County's approach offers lessons for other rural jurisdictions receiving opioid settlement funds. The county has maintained consistent funding allocations since 2022, directing 60% to peer recovery support, 20% to clinical treatment, and 20% to community-based programs. This year's estimated allocation is $42,367.

The geographic isolation that defines rural communities like Grand County—where the nearest comparable treatment programs are more than 100 miles away in Price, Utah, and Grand Junction, Colorado—makes local infrastructure essential. But the county's success also stems from coordination among providers and a recognition that recovery requires more than medical intervention.

"I think all of it combined is what helps folks heal more," Denton said of the integrated approach.

The county's declining overdose death rate suggests the investment is working. As opioid settlement funds continue flowing to communities nationwide through 2038, Grand County demonstrates that even modest allocations—when deployed strategically—can build sustainable recovery infrastructure in places that previously had little to none.