How rural and urban opioid deaths differ; one group of rural areas' overdoses are driven by many different drugs

A recently published study provides a comprehensive picture of the changing geography of the opioid epidemic. Researchers from Syracuse University, the University of Iowa, and Iowa State University tracked opioid deaths in the 48 contiguous states and cross-referenced that info with data from the Centers for Disease Control and Prevention to break down deaths not just by geography, but by the type of opioid that caused the death.

"The study finds that the opioid crisis takes different forms in urban and rural America," Richard Florida reports for CityLab. "While the urban opioid crisis is a crisis of heroin and illegal drugs, the rural opioid crisis of prescription drugs is largely a story of growing spatial inequality and of places left behind, most often occurring, as the authors note, in places that tend to have a declining industrial base."

Opioid overdose deaths have increased more than 700 percent in the most rural areas, compared to a less than 400% jump in urban areas. The epidemic can be characterized by three "waves." The first wave, in the early 1990s, involved mostly prescription opioids, mainly in rural areas. During the second wave, heroin deaths began increasing, largely in urban areas. The third wave is synthetic opioids, and is also disproportionately urban. "Such deaths are expected to soon eclipse deaths from opioid overdose in rural, non-metro areas," Florida reports.

Some areas, both rural and urban, fall into a fourth category: their overdose deaths come from many different sources, including prescriptions, heroin, synthetics, and sometimes more than one. The study calls this a "syndemic" crisis, and 4% of U.S. counties (129) fall into this category. "This syndemic opioid epidemic is concentrated in the eastern third of the nation: in Maryland, Massachusetts, rural Appalachia, stretching into Indiana, and in Michigan," Florida reports. "A third cluster is located around Santa Fe, New Mexico. Nearly two-thirds (64 percent, or 82 counties) of syndemic counties are in metropolitan areas, with 36 percent (47 counties) in rural or non-metro areas."

Many believe the opioid crisis developed from over-prescription and abuse of legal opioids, but the study found that was only true in rural areas, Florida reports.