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Alexander, G. Caleb, Stefan P. Kruszewski, and Daniel W. Webster. 2012. “Rethinking Opioid Prescribing to Protect Patient Safety and Public Health.” JAMA 308 (18): 1865. https://doi.org/10.1001/jama.2012.14282.

Dayer, Lindsey E., Jacob T. Painter, Kelsey McCain, Jarrod King, Julia Cullen, and Howell R. Foster. 2019. “A Recent History of Opioid Use in the US: Three Decades of Change.” Substance Use & Misuse 54 (2): 331–39. https://doi.org/10.1080/10826084.2018.1517175.

DeWeerdt, Sarah. 2019. “Tracing the US Opioid Crisis to Its Roots.” Nature 573 (7773): S10–12. https://doi.org/10.1038/d41586-019-02686-2.

“Drug Overdose Death Rates.” 2023. National Institute on Drug Abuse. February 9, 2023. https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates.

Hancock, Christine, and Heidi Mennenga. 2017. “Treating the Rural Opioid Epidemic.” National Rural Health Association.

Jenkins, Richard A., and Holly Hagan. 2020. “What Is a Rural Opioid Risk and Policy Environment?” The International Journal on Drug Policy 85 (November): 102606. https://doi.org/10.1016/j.drugpo.2019.11.014.

Rigg, Khary K., Shannon M. Monnat, and Melody N. Chavez. 2018. “Opioid-Related Mortality in Rural America: Geographic Heterogeneity and Intervention Strategies.” International Journal of Drug Policy 57 (July): 119–29. https://doi.org/10.1016/j.drugpo.2018.04.011.

“Understanding the Opioid Overdose Epidemic | Opioids | CDC.” 2022. October 7, 2022. https://www.cdc.gov/opioids/basics/epidemic.html.

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i know it's supposed to be footnotes but i can't rly do that in padlet :( so it's author-date instead

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i know it's supposed to be footnotes but i can't rly do that in padlet :( so it's author-date instead

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The Opioid Epidemic, Rural Communities, and a Failing System

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The Opioid Epidemic, Rural Communities, and a Failing System

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future solutions should focus on harnessing social micro environments to reduce drug-related harms and collaborating with residents to foster support for evidence-based responses to opioids (Jenkins and Hagan 2020)

telehealth can expand rural access to drug treatment (Rigg, Monnat, and Chavez 2018)

school-based prevention programs

medical education on correct opioid prescribing

public transportation

expand availability of MAT

expand availability of outpatient mental health and recovery programs (Hancock and Mennenga 2017)

expand availability of Naloxone, a medication that reverses overdoses

Most importantly, the US cannot recover from the opioid epidemic without addressing the root economic causes behind addiction. The opioid epidemic has been characterized as a "uniquely American problem" (Jenkins and Hagan 2020). A broken and oftentimes nonexistent social safety net, for-profit private pharmaceutical companies, and an economy adjusting to the impacts of automation has enabled the growth of the epidemic.

What would the United States look like if everyone could access medical treatment, regardless of their financial status or geographic location? What if there was a robust social safety net, supporting the unemployed?

Hundreds of thousands of people have already fallen victim to the opioid epidemic. How many more, until the United States fundamentally reshapes its society to support the most vulnerable of us?

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“larger and stronger kinship and peer networks” may enable the selling and sharing of prescription opioids (Rigg, Monnat, and Chavez 2018)

tendency for social identities to become fixed may exacerbate stigma and prevent recovery

stigmatization of providers who offer MAT, as the “labeling of [MOUD/MAT] as replacement of one addiction with another and the belief that needle exchange fosters drug use have stigmatized and often blocked these services in rural communities” (Jenkins and Hagan 2020)

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homelessness/marginal housing without homeless outreach programs of urban areas (Jenkins and Hagan 2020)

financial difficulties can “increase risk of substance use, in part through distress, hopelessness, and lack of control”

poverty is especially high in specific rural areas like “central Appalachia, the Delta South, the Rio Grande Valley, and Native-American reservations”

manual labor jobs lead to more workers at risk for disability/chronic pain, and being subsequently prescribed opioids

fewer and lower-wage employment as jobs are automated away (Rigg, Monnat, and Chavez 2018)

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Rural areas are less likely to have as as many

addiction treatment services and providers

detox centers

medication-assisted treatments (MATs), such as buprenorphine and methadone

drug prevention programs

drug treatment courts

harm reduction programs

as densely populated urban areas (Rigg, Monnat, and Chavez 2018).

Scarcity in resources exists "even where state-level policy and economic environments permitted a range of harm reduction services. Local decision makers often are unable to raise revenue from general funds or property tax levies to supplement the basic services supported by state and federal funds and may lack infrastructure necessary to compete for special initiatives managed by states, creating disadvantaged policy environments.”

Further, a limited public transit system prevents rural residents from accessing resources in nearby urban areas (Jenkins and Hagan 2020).

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(“Understanding the Opioid Overdose Epidemic” 2022)

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Contrary to popular belief, the opioid epidemic is not disproportionately rural. Rural areas vary significantly across the US in their rates of drug mortality

these factors make addressing the epidemic in rural areas especially difficult (Rigg, Monnat, and Chavez 2018).

However, the largest increases in opioid-related mortality rates are in heavily rural states such as Kentucky, West Virginia, Alaska, and Oklahoma. This can be attributed to significantly lower Emergency Medical Service (EMS) response times due to lower population densities (Hancock and Mennenga 2017).

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mid-1990s to 2010: prescription opioids — patient privacy laws and lack of US states allows for legitimate clinical prescriptions for opioids to be diverted from the legal to illegal market (Alexander, Kruszewski, and Webster 2012)

2010-2013: heroin — prescription guidelines retooled, supply of heroin increases and price drops

2013 onwards: fentanyl — heroin dealers cut products with fentanyl as it becomes cheaper, more available, and more potent (DeWeerdt 2019)

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New products released, including OxyContin, a sustained-release formulation of oxycodone, manufactured by Purdue Pharma. Heavy promotion by pharmaceutical companies—lobbying lawmakers, visiting individual doctors, sponsoring pain medication courses—boosts the sales of opioids. Companies emphasize opioids' “safety, efficacy and low potential for addiction of prescription opioids" (DeWeerdt 2019).

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Medical associations begin increasingly recognize pain as a problem requiring adequate treatment, the “fifth vital sign" (DeWeerdt 2019). A warning issued in 1989 proclaims that “to allow a patient to experience unbearable pain or suffering is unethical medical practice." Small, poorly designed studies and extrapolations of studies beyond their intent minimize the dangers of opioids (Dayer et al. 2019).

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Before the epidemic, opioids were "mainly for short-term uses such as pain relief after surgery or for people with advanced cancer or other terminal conditions" (DeWeerdt 2019). What followed would change that.

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Opioids provide therapeutic pain relief to millions of Americans. At the same time, there is a rising concern for the skyrocketing rates of addiction and overdose deaths. Opioid-related overdose deaths rose from 21,089 in 2010 to 80,411 in 2021 (“Drug Overdose Death Rates” 2023). The states with the highest rise in deaths are predominately rural—Kentucky, West (Hancock and Mennenga 2017). The unique infrastructural, socioeconomic, and social dynamics within rural communities highlight the elaborate societal causes behind opioid abuse and death.