The drug addiction crisis of the 21st-century wears a very different face than the drug problems of previous decades did. We face an entirely different challenge with drug and alcohol abuse today. This drug problem is particularly challenging. For example, one of the most remarkable trends of 21st-century substance abuse is that addiction is now a full-on crisis that has touched down in both urban and rural areas.
Sure enough, whereas addiction, drug use, drug crime, and other drug-related problems had more or less been an issue that big cities contended with in the past, drug problems moved out into rural America in the early-2000s and started wreaking havoc there. Rural America had no idea what hit it. Rural communities never really struggled with these problems before, so dealing with them now came as a pretty significant blow.
What caused the sudden change in the geographic focus of drug trafficking, misuse, overprescribing, diversion, and addiction?
OPIOID PRESCRIPTIONS NOW TWICE AS COMMON IN RURAL AMERICA
According to a shocking piece in U.S. News, recent studies show that Americans living in rural areas are almost twice as likely to be prescribed painkillers as their urban peers are. Such information suggests that more must be done to curb opioid prescribing by the doctors working in rural geographics.
How did this information come about? U.S. News began by examining data published from Athenahealth, a significant medical data gathering and management firm which collects and processes data for hospitals and doctors nationwide. The group had performed a three-year research project from 2014 to 2017 which examined opioid prescribing trends in both urban and rural areas.
The Athenahealth research found that opioid prescribing trends declined in urban areas from about 2016 onward. Experts believed that the CDC's document, “Guideline for Prescribing Opioids for Chronic Pain: Recommendations” published in March 2016 was a big motivator in this decline. It's very likely, with the Centers for Disease Control and Prevention, a major federal institution demanding a reduction in opioid prescribing, we can see why doctors in urban settings would curb prescribing.
But rural health centers and prescribers seemed to have missed the message.
According to Macarena Garcia, CDC investigator and contributor to the Athenahealth research, "Patients in the most rural counties had an 87 percent higher chance of receiving an opioid prescription compared with persons in large central metropolitan counties during the study period."
Let's take a look at the disparity in prescribing trends, urban to rural. According to the research, 7.4 percent of patients across America received an opioid prescription from 2014 to 2015. From 2016 to 2017 though, the number of patients receiving such a medicine declined to 6.4 percent.
So this is good news. Overall, the prescribing trend is receding. However, further research shed light on the sheer disparity between prescribing patterns in urban areas and rural areas. For example, only 5 percent of patients in urban America received prescriptions for opioids, whereas 9 percent of patients in rural counties received opioid painkillers.
What this essentially tells us is that the medical communities in rural areas are not getting the message, the message to curb opioid prescribing.
EXPERTS COMMENT ON THE ISSUE
According to Dr. Robert Glatter, an emergency physician at Lenox Hill Hospital in New York City, "The study provides a wake-up call regarding the prescribing habits among primary care providers, and the stark contrast in rural compared to urban settings. Armed with this data, it's clear we need to develop interventions and direct resources to make changes in prescribing preferences in rural settings."
Dr. Harshal Kirane is the director of addiction services at Staten Island University Hospital. He said, "The overall decline in opioid prescriptions is encouraging news." But the doctor also went on to say that, "In communities with limited access to addiction treatment, decreased access to prescription opioids can contribute to a surge in demand for heroin or illicit opioids." The doctor goes on to talk about how if we are going to encourage rural doctors to prescribe fewer opioids than we also need to present such doctors with alternative options for their patients, both for pain relief and addiction treatment.
LOOKING TO THE FUTURE
Much must be addressed if we are going to overcome this problem. And there is no easy solution to it either. Rural Americans traditionally are older, they have poorer qualities of living, and they struggle more economically. Not all rural areas are like this, but the trend is the trend. Rural Americans also tend to be more labor-involved in their careers, given that most agriculture, manufacturing, mining, fishing, ranching, and foresting takes place in rural communities.
So you have a situation where the demographics of the population who are most likely to struggle with physical pain are also least likely to be able to afford or have access to other, more sensible and safer methods of pain relief. Furthermore, this is a demographic that has already been exposed to opioid pain relievers. Bringing them down off of such drugs is not going to be an easy venture. But it is something we must do or else this problem will continue to advance and worsen.