An opiate and drug epidemic has been spreading throughout our country, one that has affected nearly 9.5 million people in the United States. Although many Americans know it is a prevalent issue, many aspects of it in the rural country lives of many Americans do not get highlighted.
With the recent COVID-19 pandemic, communities internationally have been hit hard with growing societal and economic concerns. Examples of this include millions of livelihoods being put at risk due to food insecurity and loss of jobs and work. According to the Robert Wood Johnson Foundation, around 36% of households with children face issues with keeping their children’s education going. 43% of rural households report adult household members have lost their jobs or gotten their wages reduced, and 66% of these households report serious financial problems. To cope with these seemingly never-ending struggles, some are turning towards drug use as an anchor.
Beginnings of Increased Opioid Abuse
At the start of the 2000s, opioid substance abuse cases increased exponentially due to the introduction and supply of new opioid drugs, such as heroin. This sudden overuse of opioids, combined with the introduction of stronger and deadlier drugs, led to the opioid epidemic being declared a national health emergency in 2017. Over 116 Americans were fatally overdosing per day in 2016, causing a spike in HIV and Hepatitis C disease transmissions because of dirty and shared heroin syringes.
Opioid abuse can be seen as a cause-and-effect system. Due to injuries, patients are prescribed opiates, and while trying to numb the pain, opiate usage becomes more continuous, causing the brain to adjust to the effects of the drug over time. Drug insensitivity causes many individuals to search for a stronger, more potent drug, even if it can be deadly.
Heroin is one of the leading opioid drugs and it was notorious for spiking overdoses all around America around the 1990s-2000s.
There is both a historical and social aspect to the increase in heroin usage. Heroin is an opioid drug created from morphine, which was originally a part of the group of medicines called narcotics analgesics, or pain relievers. However, when fentanyl was introduced to the drug industry as fifty times more potent than heroin and one hundred times stronger than morphine, it became a major contributor to fatal and nonfatal overdoses in the U.S. The rate of overdose deaths involving synthetic opioids in 2021 was approximately 22 times the rate in 2013.
In the 1980s and 1990s, heroin began to evolve from fentanyl to benzodiazepines, leading to more individuals smoking and snorting the drug. According to PBS, “Usage of heroin increased significantly in the 1990s. Historically the majority of the drug entered the U.S. through the French Connection or the Golden Triangle of Southeast Asia (Burma, Thailand, Laos); however, since 1993, South American drug organizations have been expanding from the cocaine market into the heroin market.”
Relations Between Crises and Addiction
Around the 2000s, the rise in drug usage can be seen to have been attributed to the financial crisis of 2008. In the market crash, many people lost their homes, property, belongings, and jobs. A study conducted during this time showed that 60% of people admitted to having participated or experienced an increase in substance use. It was noted that most people in this study mainly belonged to lower socioeconomic groups.
Many rural areas have yet to rebound and rebuild what they have lost to the recession. Many factors can cause distress among communities. States of vulnerability, fear of living conditions, and financial stability are often the main contributing factors for accelerated drug use.
Another contribution to the rise in overall drug use is the number of people who get a hold of these drugs, through legal or illegal means, and sell them for profit. Currently, this can lead back to the economic hardships caused by COVID-19 that were previously mentioned that caused the distress and hopelessness of millions of people.
Impact on Rural Communities
The development and evolution of harsher drugs increased drug usage and the selling of drugs. To narrow it down, it is evident that the brunt of drug usage disproportionately affects the more impoverished communities in America. As shown from the data and statistics provided by the C.D.C. and the United States Department of Agriculture, poorer communities in rural America are suffering from the drug epidemic the most. The overdose rate in rural communities was shown to be 45% higher than in cities.
There is a deeply disheartening relationship between poverty and addiction. People in poverty are more prone to substance abuse than others. Poverty is known to increase stress and the feeling of hopelessness, causing many to turn to substances to rid themselves momentarily of their reality. Henry Westblade ’26 explains that in his rural community in Louisiana, “Drug usage is more prevalent in lower classes who are in poverty. I think it is due to the rural areas that they live in, and people begin to use drugs because there is not a lot to do there, and they think it is the best resort.”
Unlike urban regions, rural areas have limited job opportunities. Many people in rural communities work in intensive labor, including manufacturing, agriculture, and mining. Since these jobs are more laborious, they can lead to dangerous injuries. Some injuries include ones that are caused by overexertion or dangerous environments and workplaces, such as cuts, slips, and collisions. Many are living paycheck to paycheck, so the more time they are unable to work, the more desperate they become about their current situation. These injuries can take both a physical and mental toll on workers.
Over-Prescription
Another factor that has also greatly perpetuated the opioid crisis is over-prescribing doctors. There are two cases. Some physicians generally mean well, and overprescribe both antibiotics and opioids because many doctors are used to prescribing in multiples of 30. They normally do 30 for a monthly supply. Prescribing 5 or 10 will most likely cause phone calls from pharmacists asking for refills, many doctors overprescribe to prevent this waste of time. Many also overprescribe because these doctors don’t want their patients to be in pain.
However, some doctors are the opposite of this. Sometimes there are, what’s referred to as, “pill-mill” doctors who set up a “business” accepting payment in exchange for prescriptions.
With these over-prescribing doctors, whether they had good intentions or not, people become more reliant on the opioids that are supposed to help the pain, and as opioid users begin to develop tolerance against these drugs, users also start to up their dosage.
Difficulty When Dealing with Sobriety
With higher opioid usage, people who use drugs have a harder time tapering off of them, and it becomes more difficult for them to stay sober. Sobriety can be extremely difficult for opioid addicts with injuries because to try and lessen the pain of their injury, they feel the need to take more drugs. Even after their injuries are healed, many continue to use opiates when they do not need to because of their repetitive drug usage.
When a person develops an addiction to a substance, the brain begins to change the way that it responds to addictive substances. Instead of a simple, pleasurable surge of dopamine, many drugs of abuse — such as opioids, cocaine, or nicotine – cause dopamine to flood the reward pathway, ten times more than a natural reward. The brain then develops to this change and becomes less sensitive to dopamine. Trying to achieve this original “high” of dopamine becomes increasingly more difficult and important.
Many try to go cold turkey, but the withdrawal symptoms can be severe and incredibly dangerous for users. These symptoms can include muscle pain, fever, nausea, tremors, heart palpitations, and violent mood swings. The entire process can be so dangerous that people can die of opiate withdrawals if they try to completely cut themselves off.
This process of sobriety is extremely difficult and strenuous for many, and it takes a lot of willpower to go through it. Many try but eventually fall back onto drugs because they have been so accustomed to using substances that it affects every part of their life, body, and mental state. It’s also important to note that many people in these communities do not have the support that could help them through dealing with such a difficult process.
Intergenerational Cycle
Another disheartening fact is that in many rural communities, there can be an intergenerational cycle of substance abuse. This is when one person can pass on trauma or substance abuse to their families, friendships, and relationships. This substance abuse then becomes shared among these people and perpetuates substance abuse among closed communities.
Being surrounded by people who are abusing drugs, can eventually influence the other people around them. There is evidence that problem behaviors such as harsh parenting, substance use, and emotional distress are transmitted across generations. This is a common explanation for why there are families or groups of people who struggle with addiction and trauma together.
What Can Be Done?
Ultimately, the main issue lies with the underfunding of low-income communities and the amount of support provided by the government. Although there has been more action toward awareness of drug abuse and its signs, this issue continues to persist, and it is still important to be aware.
One can also look out for signs of addiction, and reach out to whoever might be suffering. Some indications of this can be noticing new health issues, changes and swings in mood and behavior, recurring financial problems, new or increased drug paraphernalia, or experiencing problems at work or school. Reaching out can be incredibly helpful for someone going through a difficult time.
The government is currently working on providing multiple services to ensure that they can try and reduce overdose risk and mortality. The National Drug Control Strategy is trying to expand access to high-impact harm reduction interventions such as naloxone, drug test strips, and syringe services. Another way is that law enforcement agencies are going after drug trafficking and illicit drug profits, including Customs and Border Protection and Drug Enforcement Administration.
The bigger issues that need to be addressed are problems such as permanent poverty, long-term unemployment, and worsening living conditions in societies. However, increasing treatment resources, drug education, preventative social programs, and treatment can also make a big difference. It is important to address drug abuse and to help the ones in need instead of turning them away.
According to PBS, “Usage of heroin increased significantly in the 1990s. Historically the majority of the drug entered the U.S. through the French Connection or the Golden Triangle of Southeast Asia (Burma, Thailand, Laos). However, since 1993, South American drug organizations have been expanding from the cocaine market into the heroin market.”