The opioid crisis has been at the forefront of the American consciousness for almost a decade now. Yet, some communities are only now realizing just how hard they have been hit. Unfortunately, there’s a culture of silence around opioid use that has not only led to hushed discussions, when they do exist but also provides a double-whammy because rural Americans suffer out of the limelight in places society’s problems don’t warrant a column much less make front-page news.

 

Not only is the crisis hitting rural communities harder, but until 2019, overdose death rates were growing steadily higher in rural areas when controlled for population size. Now, the rates are higher among rural females than males. This is occurring despite a downward trend in national opioid prescription rates since 2012.

Why has rural America suffered disproportionately from the opioid crisis? More importantly, what can be done to fix it? The answers are complicated, but fortunately, finding a light at the end of the tunnel is possible.

 

Why Opioids Hit Rural America So Hard

Pain is pain regardless of where you live, but if you live in rural America, you have fewer options for just about everything. Rural Americans have less access to healthcare in general, but they also have little-to-no access to pain or addiction specialists. There are many resources for mental health and addiction recovery services, but people in rural communities often have limited access to these and are, therefore, left to either battle an incredibly addictive drug on their own or rely solely on the limited care provided by health officials who may not have opioid addiction experience.

 

It’s not just a lack of access to specialists: research from 2016 showed that chronic pain is also more common in rural areas. The CDC also found that high-impact chronic pain is also more likely to impact: women, older adults, currently unemployed adults, adults living in poverty, and adults on public assistance. Why is this the case? It’s unclear in part because pain is both its own condition as well as a symptom of other chronic conditions.

 

What’s more, there’s a shocking lack of data on the subject. Rural healthcare staff and community leaders know that they need programs to reduce overdoses and prevent addiction, but they don’t necessarily know how many people in their communities need these programs or if the current programs are meeting the unique needs of each group. A county in West Virginia attempted to do a survey to better understand the scale and scope of the issues they face, but it was a project completed independently.

 

The West Virginia Cabell County project did create a toolkit for other community leaders. It can be found on the Rural Opioids Count project site. An hour away from Columbus, the Dayton Fellowship Club is doing similar work for its community. The project provides various events that support socialization not based around drug or alcohol use, such as dances, camps, and round table discussions. For some Dayton residents, the need for the services of the DFC comes because so many doctors are prescribing opioids. And in Columbus alone, more than 170 million opioids were distributed between 2006 and 2012.

 

What Will It Take To Solve the Opioid Crisis?

Solving the opioid crisis, in general, requires bringing awareness to the problem. For rural communities, there are serious barriers to creating that initial awareness. The whole process requires a significant amount of inter-agency and cross-group collaboration.

 

A significant amount of resources from the federal government right down to local initiatives are currently working on the issue. These include the Rural Communities Opioid Response Program, the Rural Opioid Federal Interagency Working Group, Drug Overdose in Rural America, Farm Town Strong, and Pain and Opioid Use Disorder. Every department from the CDC to the Department of Agriculture to the Indian Health Service is involved.

 

Why does the task demand so many resources? First, opioid use takes on many different forms that defy stereotypes. The people who misuse opioids can be teens stealing pills from their parents’ nightstands, older adults with chronic pain, and workers with debilitating injuries. Any one of these people can wind up finding themselves using and then abusing pain relievers. When they’re met with the geographic, social, and economic pressures, the problem compounds.

 

Such a complex problem requires a multi-faceted solution: no one answer will do.

 

Interventions Providing Hope to Americans Facing Opioid Abuse

It’s not enough to stop the flow of opioids in rural America. There are people who need prescriptions to manage chronic conditions and who are at risk of abuse but who have managed their use. What’s more, the transition from prescription opioids to illegal drugs like heroin means that getting rid of pills won’t help the people affected now. There’s also evidence suggesting that as prescriptions become harder to get and heroin becomes more available, some people are more willing to transition.

 

Another important contribution to helping rural communities is the prevention of overdose deaths. Opioid reversal drugs can prevent fatal overdoses, and drugs like Naloxone are safe and relatively inexpensive ways to save lives in situ. Other drugs like Suboxone can help patients withdraw from opioids safely and more comfortably, which means they’re more likely to complete the initial phase of withdrawal and move on to other interventions. However, it can be difficult to find in rural areas because only a select group of approved, trained healthcare providers can prescribe it. Only 29.8% of rural Americans live in a county with access to a provider compared to 97.8% of urban-dwelling Americans.

 

Drugs are available to help rural Americans get clean and prevent fatalities, but interventions for staying clean are desperately needed and far more complicated. For those still dealing with chronic pain, there needs to be a suitable program to help them live without opioids. However, they also need peer support in the form of care, mentorship, and ways to discuss their transition with others. And community partnerships are incredibly important. Legal recourse can also be an effective means of helping curb the growing crisis, but this must be handled delicately. In the end, it takes a village of professionals all working towards the same goal to reduce and prevent addiction and relapse.

 

Always Remember the Vulnerable Populations

As different stakeholders ponder the answers to the opioid crisis, it’s as important that these partnerships remember to cater to vulnerable populations. Older Americans and people at an economic disadvantage are more likely to find themselves facing an opioid issue in the first place. Any programs created would need to keep this in mind and ensure that the programs don’t remain out of reach for the most vulnerable patients. The issue doesn’t only relate to cost: things like driving to get to meetings, finding a job, and getting basic social support at home aren’t things that any partnership can take for granted.

 

Ultimately, rural Americans know they need help, and they’re asking for it. Getting that help, however, will continue to require many groups, agencies, and individuals to work together.