Rural America in Crisis: The Changing Opioid Overdose Epidemic

Posted on by Rita Noonan, PhD

The scenery aerial view of Poconos, Monroe County, Pennsylvania, USA.

In America, 15 out of 100 people live in a rural area.  I loved growing up in a rural community, where there were actually no stop lights, everyone knew their neighbors, and doors were always open. But, my years of working in public health has taught me rural areas are not that different from urban areas when it comes to the devastating impact of the opioid epidemic.

The rate of drug overdose deaths in rural areas has surpassed rates in urban areas, and it is a huge public health concern. Understanding how rural areas are different when it comes to drug use and drug overdose deaths, including opioids, can help public health professionals identify, monitor, and prioritize their response to this epidemic.

One Epidemic – Three Waves

Drug overdoses in the United States have now surpassed other leading causes of death like AIDS or motor vehicle crashes, even when they were at their peak.

The opioid overdose epidemic has come in three waves:Rural: Areas with low population, where there is a lot of space between residences. Urban: Refers to areas like cities, with high population and population density.

  1. Increases in deaths involving prescription opioids starting in 1999
  2. Increases in heroin-involved deaths starting in 2010
  3. Since 2013, we have seen more deaths involving synthetic opioids like illicitly manufactured fentanyl.

CDC is tracking how these waves of overdose deaths are affecting rural versus urban areas of the country to help states and public health departments identify, monitor, and prioritize customized prevention responses.

Rural Communities at Risk

Death rates for unintentional injuries like drug overdoses, falls, and motor vehicle crashes are around 50% higher in rural areas than in urban areas. In general, people who live in rural areas of the United States tend to be older, poorer, and sicker than those living in urban areas. Differences in socio-economic factors, health behaviors, and access to health care services contribute to these differences. From 1999 to 2015, the opioid death rates in rural areas have quadrupled among those 18-25 years old and tripled for females.

Preventing Overdose Deaths in Rural America

Overdose deaths can be prevented through improved public health programs. We can start addressing the opioid overdose epidemic and save lives by:

  • Understanding the differences in burden and context of drug use, drug use disorders, and fatal overdose, and identifying how to tailor prevention efforts to local situations between rural and urban areas.
  • Teaching healthcare providers about safer opioid prescribing practices and how to treat patients with opioid use disorder (addiction).
  • Considering non-opioid pain treatment options, like exercise and physical therapy, cognitive behavioral therapy, or more effective pain medicines (like acetaminophen, ibuprofen, and naproxen). Some of these options may actually work better and have fewer risks and side effects than opioids.
  • Supporting training and access to naloxone, a medication that can quickly stop an opioid overdose, for high-risk individuals, families, emergency responders, and law enforcement.
  • Increasing access to treatment for opioid use disorder (addiction) through medication-assisted treatment or comprehensive services to reduce infections from injection drug use, like HIV or Hepatitis C.
  • Working with public safety to share data, scale up evidence-based strategies, and decrease the illicit drug supply.

The landscape of drug overdoses in America is changing and affects everyone, no matter where they live. As the epidemic continues to evolve and change, we must understand the circumstances that contribute to opioid deaths and remain vigilant to prevent overdoses in our communities. The more we understand about this drug epidemic, the better prepared we all will be to stop it in its tracks and save lives.

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8 comments on “Rural America in Crisis: The Changing Opioid Overdose Epidemic”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

    I thoroughly enjoyed your blog especially considering my community and the place that I work is fighting this epidemic today. I can see the correlation between rural areas and opioid addiction. I had a friend that lived in Lancaster, PA who unfortunately was a drug addict of wide variety of drugs but his go to was heroin. When asked why he feels the need to participate in drug usage, he stated “it is something for me to do.” When I had him elaborate on his statement I learned that there is not much to do in Lancaster. It is very boring from a teenager’s standpoint. Therefore, they are seeking out ways to entertain themselves. Drug usage in this area is popular. There has to be a solution to drug addiction in rural areas. Yes the socioeconomic status of these areas are extremely low but what if activities were made available for these individuals. Maybe by opening up more attractions such as movie theaters, amusement parks, skate parks, or museums, these will create jobs and give the youngsters more activities to participate in. I also agree with the solution of using non-opioid pain treatments as an option. Working in the surgical environment, I observe many surgeons giving patients opioid medications for little lesions being removed such as moles. As the nurses of the facility, we should advocate for other means of pain relief such as the ones suggested in your blog. I am a huge advocate for meditation and pain relievers such as ibuprofen and tylenol. I understand the need for pain medication such as the opioids on surgical procedures that require it for comfort. I believe that they are being overused by surgeons and physicians. We as the healthcare providers need to advocate for the patients and give them the options they deserve.

    I found you blog to be informative and helpful, as the opioid epidemic is something I am dealing with in my local community as a primary care nurse. I currently reside on Cape Cod which is a rural are in a sense because of the isolation from cities. State and federal law makers have been making strides to deal with the epidemic. A new law trying to be passed by the Massachusetts governor imposes involuntary treatment for those with opioid addiction. Many of the patients range in age but all live on the Cape year round and have started abusing opioids and heroin for many reasons but the common reasons are mental illness, family history, and boredom. There are not many areas on the Cape that offer mental health services and the ones that do are at capacity. Many patients have to travel anywhere from 45 minutes to 120 minutes for mental health providers which can present a problem for those who do not drive. The focus on providing more access to mental health providers may allow for more comprehensive treatment for opioid addict patients.
    The blog also discussed nonopioid medications options and safer use of opioid medications. I have recently seen multiple patients with a history of opioid addiction receive opioid medication for pain related to an injury or recent surgery. It is our duty as healthcare providers to advocate for patients in these situations to help maintain their sobriety. As a nurse I continue to advocate for my patient’s care.

    Thank you for your blog, I enjoyed reading it and have learned a lot from it. In the most recent years opioid overdose and misuse had been in the midst of controversy and topics. It has a lot of negative effects and affected plenty of people in their every day lives and their family. It is alarming how the opioid epidemic is affecting our community. It is particularly alarming that it seemed to be growing in numbers over the years. According to CDC, in 2015 drug overdose had led to approximate 52,000 deaths. Overdose rates in the rural area showed at a higher trend with a rate of 17.0 per 100,000 according to CDC. Although there was no singular particular race, age, or sex, it is apparent that it is a growing epidemic that needed to b addressed to keep a health community.

    Let me ask this what is worse ? Pills or heroin? The more we restrict pills the more we make people turn to heroin . I was on pills but went to heroin because it was cheaper n easier to get
    .if u ask me pills are better we know what is in them and it would make a big hit to the heroin trade if we made pills legal to a point .luckily i got clean after I almost died on heroin it opend my eyes .
    Would you rather fund drug trade and get something you have know idea what is in it ,or pills that you know what is in it and money can be used to help stop addiction.. So why are we making it easier to get heroin.
    There will always be addiction dont be ignorant, don’t start another prohibition make pills the choice not heroin

    Having grown up in Southern Ohio, and now living in Southwest Ohio, the opioid epidemic is a very real part of my daily landscape. I’m a nurse with a background in NICU and neonatal abstinence syndrome treatment, and the impact of addiction is more widespread than I think people really realize. Preventing overdose deaths can potentially give someone the second (or third, or fourth) chance that they need in order to seek the treatment that they need and deserve. If we approach addiction from the point of view of trauma-informed care we can better understand the position of the affected person. Drug abuse is related to maladaptive coping mechanisms, but if we can help someone replace those coping mechanisms, shouldn’t we? A former drug abuser that I worked with explained it to me like this: sure, the first time you use is a choice, but after that it isn’t. She explained that even if she didn’t want to, that high was the thing that took her out of the pain of her current situation, if temporarily. Most of these people have been hurt in ways that we can’t even contemplate. The ways to prevent overdose deaths discussed in this blog post are a fantastic start to helping decrease deaths and increase awareness throughout the medical community. People with addiction are just that: people. It’s really easy to dehumanize these individuals, but they truly are humans. I’ve met many of the “real” people behind the addiction, and it was my privilege to be able to help them.

    I really enjoyed reading this blog. I didn’t realize how much of an issue opioids are in rural areas. I suppose I had just assumed there were more issues in urban areas due to easier access to prescription drugs and “street drugs”. I side with your thoughtful strategies to help prevent overdose deaths in the country. Your strategies cover all three preventions. I would also like to add possibly creating more education with the youth. Maybe a guest speaker in their gymnasium to speak on the issue of opioids. Again, your blog was an excellent read.

    Increased prescription of opioid medications led to widespread misuse of both prescription and non-prescription opioids before it became clear that these medications could indeed be highly addictive. Policymakers can create laws about substance abuse prevention and treatment needs in their communities.

    I believe in order to combat the opioid epidemic, there must be many avenues of approach. Pre-emptive and reactive care from the patient’s perspective must be available and affordable. I have read a few studies were implementing new procedures in the emergency room and in post-surgery care has been effective from a pre-emptive standpoint. If a patient is high risk, implementing a care plan where opioids isn’t necessarily the “go to” option is ideal. There are topical options available to substitute opioids in some instances. All medical staff that is under the supervision of a high-risk patient should be aware of the individual’s status at all times in order to make informed decisions moving forward.
    Reactive care, such as rehabilitation, for opioid addicted patients should be available and affordable. Not only does opioid addiction take a toll on the individuals health but is costly for the health care system. I would be curious to see the cost effectiveness between pre-emptive care and reactive care for opioid addiction.

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Page last reviewed: November 29, 2017
Page last updated: November 29, 2017