Due in large part to a devastating opioid epidemic, drug-related deaths have become a major public health problem in the United States in recent years. More than half a million drug-related deaths occurred in the U.S. between 2006 and 2015 alone. But this epidemic isn’t affecting all regions equally. Certain areas across the country are carrying the majority of the economic, social, and emotional burden brought on by drug overdoses and drug-related deaths.
The first national study of county-level differences in drug deaths within the U.S. – reported in the American Journal of Preventative Medicine – has determined that addressing economic and social conditions will be our best hope for stemming the rising tide of this public health crisis.
“The drug epidemic is a pressing concern among policymakers,” says Shannon M. Monnat, and associate professor of sociology at Syracuse University. “The media portrayal of the drug overdose epidemic has largely been that it is a national crisis. However, drug deaths are not randomly distributed across the US. My analyses show that some places in the US have much higher drug mortality rates than others.”
Monnat used data from the US Centers for Disease Control and Prevention Multiple-Cause of Death Files (2006-2015), US Census Bureau, US Department of Agriculture Economic Research Service, Agency for Healthcare Research and Quality, and Northeast Regional Center for Rural Development in order to study the associations between county-level drug-related mortality rates and the economic, social, and health care environments of specific counties. The results showed that the average county-level age-adjusted mortality rate due to drugs was 16.6 deaths per 100,000 people. However, there were significant geographic differences for the range of mortality rates, with some counties having more than 100 drug-related deaths per 100,000 people.
The highest mortality rates were clustered in Appalachia, Oklahoma, northern California, and parts of the Southwest. The lowest mortality rates were found in Texas, the Great Plains, the Black Belt, and parts of the Northeast. Monnat found that average mortality rates were much higher in counties with more economic and family distress, as well as counties that were dependent on the mining industry. For counties with the highest levels of family distress – like divorce, separation, and single-parent families – their drug mortality rates were eight deaths per 100,000 higher on average than counties with the lowest level.
Other factors associated with lower average mortality rates include larger presence of religious establishments, greater percentage of recent immigrants, and counties with economies that were more reliant on public sector employment. Although there were no differences in average mortality rates between rural and urban counties, some rural counties – particularly those in Appalachia – have the highest mortality rates in the nation.
Monnat believes that social and economic environments are imperative for preventing these deaths, as they play a role in stress reduction, healthcare investment, and citizens’ knowledge about and ability to access services and social support. They also facilitate opportunities for social interaction, creating positive environments and outlets for people in the area. But the most important change we need to make may just be getting honest about the nationwide health crisis.
“We need to get real with ourselves about the US drug problem. We are not going to Narcan our way out of this,” Monnat laments, referring to the widely-used “miracle” drug that revives people after they’ve overdosed. “Opioids are a symptom of much larger social and economic problems. Just as other chronic diseases have underlying social determinants, addiction is also a social disease. ‘Addiction does not discriminate’ is a soundbite that ignores the reality that overdose rates are highest in economically distressed communities, particularly places that have experienced declines in job opportunities for people without a college degree. Addressing economic and social conditions will be key to reversing the rising tide of drug deaths.”