Once associated with wholesome adventures and built-in innocence, rural America has been a place people want to raise their children. Populated with tight-knit families and trusted neighbors, small towns have symbolized open doors, potluck dinners, high school sporting events, Fourth of July parades, and gossip.

These rural communities cultivated peace of mind. A place where mothers and fathers feel comfortable watching their children get on their bikes first thing after breakfast and not expecting to see them again until dinnertime. Generation after generation following in their parents’ footsteps.

People stayed in these rural communities because it was quieter. Simpler. Safer. Free from the pitfalls of city life.

But is it?

Not according to the U.S. Centers for Disease Control and Prevention (CDC). In fact, over the last decade, issues once associated with city life have slowly creeped into rural areas. Opioid misuse, often perceived as a problem of urban areas, has found its way into America’s small towns. Now, these communities are faced with the resulting loss, crime, and destruction that accompanies misuse of opioid prescription drugs such as OxyContin, Oxycodone, Vicodin, Fentanyl, and of the illegal counterpart, heroin.

A report by the CDC reveals that drug overdose deaths are rising in rural areas across the U.S. In 2015, the overdose death rate for rural areas surpassed the death rate for urban or suburban areas and people living in rural areas were four times more likely to die from overdoses in 2015 than they were in 1999.

In 2015 alone, opioids were involved in more than 33,000 deaths; four times the number of opioid-involved deaths than in 2000. The epidemic impact reaches others, too: a recent University of Michigan study that found rates of babies born with opioid withdrawal symptoms rising much faster in rural areas than in urban areas.

A Landscape of Prescription Painkillers

So what’s happened? How is it that these idyllic small towns, once rich with multi-generational small businesses, farms and ranches, have been reduced to main-drag strips fraught with dealers and dotted with big box stores and fast food chains? For a culture that marks time by the seasons, the opioid crisis is a perfect storm of circumstances.

Some speculate that the recession of 2008 is a factor, as many rural areas still have not rebounded. Unemployment, falling incomes, businesses closing down and dwindling community resources have made it all but impossible to improve living conditions. Fear, stress, and emotional distress over living conditions and financial stability are often major contributors to substance abuse.

To understand the opioid epidemic, it’s important to see that it has come in three waves, each building on the one before it; magnifying its traction.

A Perfect Storm for a Health Crisis

The Great Recession that began in 2007 is partly to blame.

Over the last decade these towns have seen a significant drop in unemployment and they still haven’t recovered. Slowly, family-owned businesses have dissolved and the chance to earn a good living has been replaced by limited and poorly-compensated service jobs. Readily available opioids have become “drugs of solace” that mask physical and emotional pain in a world offering little hope that conditions will improve.

Labor-Intensive Jobs + Overprescribing = Addiction

Many people in rural areas work jobs in mining, manufacturing, and agriculture which often lead to chronic pain or injuries. These jobs are often physical and sometimes dangerous. As a result, chronic pain and injuries are more common, and the cost of taking time off from work to heal is so great that many have come to rely on opioid pain medications just to keep working and functioning. What starts as a legitimate prescription for pain can often lead to an addiction to opioids. Rural doctors are often overworked, and treatments for chronic pain, such as physical or occupational therapy, are limited. Some say opioid prescriptions became the go-to for rural physicians and the beginning of an addiction for some patients.

Small Town Strong - Social and Kinship Networks

Family relations, family life, and community ties are the fabric of small town support systems and social lives. People work hard, look people in the eye, and know each other’s business. These social and kinship networks operate on trust for each other. The community is built on trust, reciprocity, and cooperation. Friends and neighbors help each other out, share resources, and work together. So it’s not uncommon to sustain an injury on the job, receive a prescription for an opioid, and then share or sell the prescriptions among each other.

According to the National Institute of Drug Abuse, people often share their unused pain relievers, unaware of the dangers of nonmedical opioid use. Most adolescents who misuse prescription pain relievers are given them by a friend or relative.

Healthcare Access Compounds the Problem

Stigma and judgement, not knowing what pain-management questions to ask a physician, lack of local treatment facilities, and an absence of health insurance are just a handful of the challenges that patients with an addiction face in rural communities. In these depressed communities, comprehensive substance abuse treatment services are limited at best and absent most often.

Lack of resources and funding lead to a limited health and social service infrastructure. Not having access to evidence-based treatment such as Medication Assisted Treatment (MAT) or support services for long-term recovery coupled with shortages of mental health providers only serve to fail these vulnerable populations.

The absence of treatment services locally results in patients having to travel long distances to receive the proper care they need. It’s been shown that having to travel long distances to receive substance abuse treatment often results in lower completion rates of substance abuse treatment programs. The ultimate challenge is figuring out how to get rid of these barriers to treatment, so these rural communities can become strong again.

Meeting Access Challenges

In response to the opioid crisis, the U.S. Department of Health and Human Services (HHS) is focusing its efforts on improving access to treatment and recovery services, promoting use of overdose-reversing drugs such as naloxone, ongoing research to better understand the epidemic, pain and addiction research, and advocating for alternative pain management practice.

But what can be done to combat this epidemic while waiting for these improvements? The National Safety Council suggests taking these steps to fight the opioid epidemic:

1. Never Mix your medications - Mixing alcohol and other drugs with opioid painkillers can intensify the effects.
2. Get rid of expired and unwanted prescriptions - More than half of people who misuse opioid pain relievers get them from a friend or family member.
3. Request an Opioid Warn-Me Label - To keep fewer pills out of circulation to begin with, you can request an Opioid Warn-Me label from NSC. A Warn-Me Label on an insurance card or prescription card is a sign to doctors and pharmacists that you want answers to the following questions:
   1. Am I being prescribed an opioid?
   2. If so, is there a non-addictive alternative?
   3. If not, is a short-term prescription possible?
   4. Do I have any medical conditions, mental health issues or a family history that could increase my risk?
4. Talk to your children about the risks of Opioid Painkillers - Warn children that taking a drug that wasn't prescribed to them is just as dangerous as illegal drugs:
5. Learn how to take Opioid Painkillers safely - In select, individual cases, opioids may be one part of an effective pain management plan. Even then, patients should be monitored closely, and opioids should be used at the lowest dose for the shortest amount of time.
6. Learn to recognize the signs of an overdose
   1. Slow and loud breathing
   2. Sleepiness, progressing to stupor or coma
   3. Weak, floppy muscles
   4. Cold and clammy skin
   5. Pinpoint pupils
   6. Slow heart rate
   7. Dangerously low blood pressure
   8. Ultimately, death

For more information about responsible opioid use, or if you or someone you love is struggling with an opioid dependence, call or text us today to talk to a Behavioral Health Consultant at 509-488-5256.