Death by Prescription in Rural America
Evidence, both statistical and personal, keeps piling up that drug fatalities are increasing fastest in rural communities. And most deadly overdoses involve medications that doctors prescribe.
Data: Virginia State Medical Examiner Graphic: Roanoke Times
"This is a public health epidemic," Dr. Martha Wunsch of Blacksburg, Virginia, told Laurence Hammack of the Roanoke Times. Dr. Wunsch, an addiction expert, was describing the huge increases in drug overdose fatalities in Western Virginia, where last year more people died of accidental ODs than in auto accidents. There were 264 deaths from overdose in the region in 2006, nearly 300% more than in 1996.
The “epidemicï¿½? Hammack recounts isn’t just Virginia’s problem. It’s a national health concern, and in the rural U.S. it looks like a health emergency.
The Centers for Disease Control released a study earlier this year showing major increases in accidental drug overdose deaths across most of the country (up 62.5% from 1999 to 2004). The CDC pointed out, “Larger rate increases occurred in states with mostly rural populations.ï¿½? In the five years under study, deaths from “unintentional poisoningï¿½? (which translates to accidental drug overdose) rose 550% in West Virginia, 226% in Oklahoma, and 210% in Maine. The ten states showing the highest increases in deadly drug overdose were all among the most rural in the nation. Along with West Virginia, Oklahoma and Maine, others with the highest increases were Arkansas (195%), Montana (195%), Mississippi (185%), North Dakota (178%), New Hampshire (171%), Vermont (165%), and Kentucky (164%).
The CDC further reported that most of the increase in deaths resulted from overdoses of prescription drugs ““ particularly “opioid analgesics (e.g., oxycodone)ï¿½? ““ and sedatives, not illicit substances like heroin and methamphetamine.
The federal report confirms what earlier state studies have shown regarding both the deadliness of prescription drugs and the intensity of the problem in rural areas.
Deaths from accidental drug overdose in North Carolina, 1997-2001; counties in dark purple had the highest death rates
Map: NC Dept. of Health and Human Services
Six years ago Catherine Sanford, an epidemiologist studying North Carolina, found a high correlation between rurality and rates of unintentional death by drug overdose. “The smaller, rural counties had the highest mortality rates for unintentional drug deaths,ï¿½? she found.
Research on New Mexico, published last year, disclosed that “of the 765 prescription drug-related overdose deaths in New Mexico from 1994 to 2003, more than three-fourths were caused by opioid pain relievers.ï¿½? Methadone, oxycontin and codeine are all in this class of drugs. According to the New Mexico report, that state had the highest drug induced death rate in the country. Sidney Schnoll, of the Medical College of Virginia, noted, “New Mexico is a relatively rural state, and one of the things we know about prescription drug abuse, particularly prescription opioid abuse, is that it is more of a problem of rural areas than urban areas,ï¿½?
A Utah study of drug deaths from 1991-2003 likewise showed a five fold increase in mortalities from overdose, most of this increase from “medications that can be legally prescribed.ï¿½? The Utah report noted, “More deaths occurred in urban areas than rural areas”¦; however, the increase in death rate “¦was greater in rural areas than urban areas (317% versus 171%).ï¿½?
Opiate addiction has also been accelerating in parts of rural Maine, notably in far north Aroostook County. Statewide, overdose deaths in Maine ““ one third of them from methadone — exceeded fatalities from auto wrecks in 2005.
But why are rural communities seeing such fatal increases in prescription drug abuse?
Joel Elliott pursued the question for the Blethen Maine News last year. “Maine's rural nature and relatively homogenous culture make residents more susceptible to prescription drug addictions,ï¿½? Elliott concluded after speaking with the substance-abuse services expert of Acadia Hospital. “Tight-knit, static communities make it easy for prescription drugs to change hands between friends and relatives,ï¿½? Elliott wrote. He added, “Kennebec County is at particular risk, because it is positioned along common routes for drug trafficking between New York and the Downeast portion of the state.ï¿½?
Beth Davies, director of the Addiction Education Center in Pennington Gap, told the Roanoke paper that prescription drug addiction has become “almost a way of lifeï¿½? in Western Virginia.
Laurence Hammack's grim and thoroughgoing article describes “a region long dependent on one dominant industry, coal mining" and "a culture of not speaking out against the power structure, whether it's a coal company or a pharmaceutical firm. “˜People have been so beaten down for so long in so many ways,’ (Davies) said. “˜Some people say they are lazy and don't care, but it's not that at all. People are very wise, and they know where the power is, and it's not wielded here in the community.’ï¿½?
Dr. Len Paulozzi, the CDC epidemiologist who led the recent national report of deaths by drug overdose, stressed, “This is the first study really to describe the large relative increases in poisoning mortality rates in rural states. Historically, the drug issue has been seen as an urban problem.ï¿½? He also admitted, “We’re not exactly sure why this is happening,”¦it might be related to regional differences in drug use, in drug abuse, or even in drug abuse control measures. We’re trying to figure this out now.ï¿½?