Background: The opioid epidemic and an increase in methamphetamine use have disproportionately impacted rural areas across the U.S., resulting in increases in fatal overdoses, drug injection, and HIV/HCV outbreaks. Little is known, however, about the experiences of rural people who use these drugs when they seek medical care. We explored healthcare experiences of people who use opioids or methamphetamine (PWUOM) in rural Illinois to identify barriers to and facilitators of care. Methods: We conducted 22 qualitative interviews with PWUOM, including 19 who inject drugs, in the Illinois counties of the Delta Regional Authority between June 2018 and February 2019. Interviews were analyzed using a modified grounded theory approach where themes are coded and organized as they emerge from the data. Results: Breaches of trust by healthcare providers, often involving law enforcement and child protective services, dissuaded PWUOM from accessing medical services. Participants described experiences of violation in emergency departments (EDs), with one account of forced catheterization. PWUOM also recounted disclosures of protected health information by providers, including communicating drug test results with law enforcement and sharing details of psychiatry sessions with community members. Participants described a hesitancy common among PWUOM to call Emergency Medical Services for an overdose due to fear of arrest. Features of rural communities, including increased visibility in healthcare and law enforcement interactions and a limited number of medical service options contributed to these findings. Conclusion: Breaches of trust by healthcare providers in rural communities discouraged PWUOM from accessing healthcare until absolutely necessary, if at all. These experiences may negatively impact PWUOMs’ morbidity and mortality, as well as the health of their communities. Possible areas for intervention include stigma training for ED providers and Emergency Medical Responders, and education addressing best practices and privacy rules regarding third parties such as law enforcement in healthcare settings.