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’
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
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:
- Never Mix your medications - Mixing alcohol and other drugs with opioid
painkillers can intensify the effects.
- 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.
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:
- Am I being prescribed an opioid?
- If so, is there a non-addictive alternative?
- If not, is a short-term prescription possible?
- Do I have any medical conditions, mental health issues or a family history
that could increase my risk?
- 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:
- 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.
Learn to recognize the signs of an overdose
- Slow and loud breathing
- Sleepiness, progressing to stupor or coma
- Weak, floppy muscles
- Cold and clammy skin
- Pinpoint pupils
- Slow heart rate
- Dangerously low blood pressure
- 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.