COLUMBUS, Ohio – While the opioid crisis has touched Ohioans from all walks of life, some of the risk factors may not be random.
In an attempt to better understand how the opioid epidemic has unfolded across the country, Syracuse University Associate Professor of Sociology Shannon Monnat examined the drug mortality rates of non-Hispanic whites.
She says contrary to common belief, drug mortality rates are higher in urban areas than rural counties. However, there is wide variation.
"It is the case that some rural places in the U.S. have the very highest overdose mortality rates, but some rural places have the very lowest,” says Monnat. “So, it's really kind of a tale of two rural Americas."
Monnat explains higher rates of drug deaths were concentrated either in economically distressed mining communities, or those dependent on service-sector jobs.
"In addition to opioid supply measures, economic distress measures really matter in explaining why some places have higher overdose rates than others,” says Monnat.
Between 2010 and 2016, opioid-related overdose deaths tripled in Ohio.
Monnat says intergenerational poverty, hard manual labor, as well as the loss of manufacturing and mining industries have contributed to higher rates of opioid abuse in some rural communities.
"For a lot of people, those institutions of work and the family have unraveled over the past 30 years, and it's left some people with little meaning in their lives,” says Monnat. “And drugs are one way to escape that emotional pain or a way to escape or the reality of a lack of connection or a purpose in life."
Monnat contends these economic and social factors must be taken into account when considering solutions.
"And intervention efforts have to be specifically targeted to certain regions, labor markets, and populations,” says Monnat. “Otherwise, those efforts are not going to be effective."
She adds that future research into health-related measures and civic engagement could help determine if some communities are at greater risk as well.
Reporting by Ohio News Connection in association with Media in the Public Interest, and funded in part by The George Gund Foundation.
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Expanded treatment for opioid addiction is now available in New Mexico.
The state's Department of Health is offering medication-assisted treatment for opioid use disorder in four regions around the state.
Josh Swatek, harm reduction program manager for the New Mexico Department of Health, said medication to treat the addiction should help reduce opioid cravings.
"This is really designed to help reach some of the most rural communities, to really create a safety net," Swatek explained. "Folks have options for substance-use treatment in their local communities."
Swatek noted more than 2 million people in the U.S. have an opioid-use disorder. New Mexico previously offered outpatient disorder treatment in Las Cruces, Albuquerque and Roswell but has now expanded treatment to 30 public health offices. He pointed out in 2022, the state recorded slightly more than 700 deadly opioid overdoses.
Swatek emphasized his department is focused on harm reduction -- acknowledging people use drugs for a variety of reasons -- but can also live healthy, self-directed and purpose-filled lives by adopting specific strategies. He added research shows people are five times more likely to enter substance treatment programs and three-and-a-half times more likely to succeed if they have first participated in harm-reduction programs.
"We're working closely with the New Mexico department of corrections," Swatek stressed. "They're going to be required to offer substance-use treatment as well in their facilities, so that when folks are discharged there's a plan. No matter where they are in New Mexico, we can hopefully continue their treatment in a public health office, if need be."
Swatek acknowledged those struggling with addiction often are stigmatized by their community and harm-reduction programs can minimize risks until they're ready to take steps toward treatment or recovery. He observed some patients have told researchers telehealth has helped them have a greater sense of autonomy and control over their treatment.
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Often celebrated in popular culture, Wisconsin's relationship with alcohol continues to give way to troubling statistics that center around excessive drinking and there are calls to step up prevention efforts.
The Badger State still ranks high for beer production.
Maureen Busalacchi, director of the Wisconsin Alcohol Policy Project at the Medical College of Wisconsin, said consumption levels for all types of alcohol overshadow market gains. For example, all Wisconsin counties exceed the national average for excessive alcohol use. In 2022, the state recorded more than 3,300 alcohol-related deaths.
"This has been an ongoing problem in Wisconsin, in part, I think, how our regulatory system works, how our culture works," Busalacchi observed. "There's maybe not as much enforcement of policies as there are in other states."
She pointed out binge drinking is a major problem, and boosting age compliance checks at places that sell alcohol could help curb the activity among young adults. Busalacchi sees hope at the local level with stronger enforcement at community events, as police agencies take notice of the ripple effects of people being overserved or minors gaining access to these products.
However, she reported people who have developed a drinking problem often encounter waiting lists for treatment programs.
Faith Gladem, executive director of the Harbor Recovery Center, a nonprofit in central Wisconsin emphasizing family support in transitioning to recovery. She said they are able to meet demand through their services but referrals for more intensive help can be an issue.
"When someone needs treatment, we do not have enough treatment beds in Wisconsin," Gladem asserted. "We do not have enough detox facilities that detox with dignity."
Her team wants to help foster a mindset in Wisconsin where alcohol is put on the same level as other substance use disorders. The State Council on Alcohol and Other Drug Abuse recommends more evidence-based education and Busalacchi added it is important to understand not just the short-term effects, such as traffic fatalities but the cumulative impact as well.
"The long-term impact of alcohol use can be cancer. It can also be high blood pressure, heart disease, liver disease, stroke," Busalacchi outlined. "And then there's the social and wellness issues; your family gets frustrated or you're losing work."
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More than 1,000 New Mexicans die from drug overdoses each year, and while there's been a slight drop in overdoses from opioids nationwide, it's mostly offset by those from cocaine and other stimulants.
James Besante, chief medical officer at the Santa Fe Recovery Center, said the opioid crisis is evolving - sometimes described as "waves." Now in its fourth wave, he said the nearly 4% decrease reported by the Centers for Disease Control and Prevention is good news, but doesn't reflect what he's seeing on the ground. He noted that it's common that multiple drugs are involved in overdose deaths.
"Increasingly we are seeing individuals overdose on substances other than opioids," he said, "where their substance has been adulterated with an opioid like fentanyl."
When the United States' opioid crisis was at its peak, New Mexico was sixth among the 50 states for overdoses - about 50 individuals per 100,000 people. If preliminary CDC data showing opioid deaths decreased in 2023 is confirmed, it would be the first annual decrease in drug-overdose deaths since 2018. Besante said any success is good news and offers hope to suffering individuals and families.
About 30% of New Mexico residents live in rural counties, which Besante said are medically underserved - with fewer treatment centers and providers prescribing life-saving medications.
"While in some areas of the country we've seen an explosion of tele-medicine, tele-addiction treatment - that has not found its way into very rural communities," he said, "and oftentimes the local pharmacy is not stocking the medications that are prescribed."
In 2021, almost 107,000 drug-overdose fatalities occurred in the United States. West Virginia was the hardest-hit state, approaching twice the number in New Mexico. Besante saif approximately 25% of clients at the Sante Fe treatment center are unhoused and don't have health insurance.
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