Report: 'Deaths of despair' decrease across the country, but Appalachia still sees the highest mortality rates

Opioids are one of the biggest drivers of deaths of despair
in Appalachia. (Photo by S. Pollio, Unsplash) 

The U.S. mortality rate from "deaths of despair" has declined by 5%, according to a report by researchers at the University of Chicago and East Tennessee State University. The decrease means such deaths, which are commonly linked to drug overdoses, alcohol and suicide, are hovering near pre-pandemic levels, reports Liz Carey of The Daily Yonder. 

Despite the encouraging news, deaths of despair remain disproportionately high in Appalachia, where drug overdoses are considered the "primary factor driving the difference."

Michael Meit, the director of the Center for Rural Health and Research at ETSU and a co-author of the report, believes the reasons for the higher rate of deaths of despair in Appalachia aren't fully known. He told Carey, "I think there are a lot of complexities to it, and I don’t know if we know all of the answers."

The new report is the "latest update to research started in 2017," Carey explains. "At that time, Appalachian mortality from overdose, alcohol, and suicide was 44% higher than it was in the rest of the country." Despite a decreasing mortality rate since 2017, the number of Appalachian deaths of despair remains stubbornly higher than the rest of the U.S.

The decrease in the number of deaths by despair isn't happening evenly across all age groups. Millennials are a generation that has lost thousands of lives to deaths of despair. Carey reports, "According to a report by Trust for America’s Health, the largest number of deaths from overdoses, alcohol, and suicide in the 25- to 44-year-old demographic has steadily increased since 2017." 

The report singled out opioid addictions and overdoses as the biggest driver of Millennial deaths of despair. As a result of those findings, the Appalachian Regional Commission awarded "nearly $11.5 million in 2023 to nearly 40 projects across the region to address the impact of substance use disorder," Carey writes.

But regional progress is slow. Meit told the Yonder, "You don’t necessarily see a region-wide impact, but you see really strong community-based efforts that impact those communities. And as you reduce numbers in any given community, that has a broader impact across the region.”

Drug cartels turn to a synthetic opioid 100 times stronger than fentanyl, 'killing hundreds of unsuspecting drug users'

The chemical makeup of carfentanil. The drug is legally used to  
anesthetize large animals such as elephants and rhinoceroses. 

Carfentanil is a deadly "weapons-grade" synthetic opioid that illicit drug makers are adding to other drugs as a potent substitute for fentanyl. The drug, which authorities say is "10,000 times more potent than morphine and 100 times stronger than fentanyl, has seen a drastic resurgence across the U.S., killing hundreds of unsuspecting drug users," report Hallie Golden and Jim Mustian of The Associated Press.

Carfentanil's presence in illegal drugs sold in the U.S. has surged since the Chinese government's more recent "crackdown on the sale of precursors used to make fentanyl," AP reports. "Those regulations are likely prompting traffickers in Mexico to use carfentanil to boost the potency of a weakened version of fentanyl."

The sheer potency of carfentanil is what makes it so dangerous for anyone who takes drugs not prescribed by their doctor. Frank Tarentino, the U.S. Drug Enforcement Administration chief of operations for its northeast region, which stretches from Maine to Virginia, told AP, "You’re talking about not even a grain of salt that could be potentially lethal. This presents an extremely frightening proposition."

While some Mexican drug cartels may be making carfentanil in their own labs, others are purchasing it from darknet marketplaces. Regardless of where it originates, it's making its way onto American streets. Golden and Mustian write, "In 2025, DEA labs identified carfentanil 1,400 times in U.S. drug seizures, compared with 145 in 2023 and only 54 in 2022."

Russia used an aerosol form of carfentanil as a chemical weapon to subdue Chechen separatists in 2002, AP reports. It is legally used to anesthetize large animals, such as elephants.

Michael King Jr., founder of the Opioid Awareness Foundation, told AP, “It’s like a biological weapon. If the world thinks we had a problem with fentanyl, that’s minute compared to what we’re going to be dealing with with carfentanil.”

Reporting on Addiction launches hub for journalists covering opioid addictions, deaths and settlement dollars

As opioid settlement money continues to be divvied out to state and local governments, reporters can help their communities understand where the money is coming from and discern who and how their regional governments are spending it.

Reporting on Addiction, a collaborative project of the Opioid Policy Institute and 100 Days in Appalachia, provides reporters with an "Opioid Settlement Resource Hub" filled with robust story ideas and insights to use when covering the history, dollar amounts, tools and impact of opioid settlement funds in local communities.

For journalists looking to explain the history of opioids in the U.S. and the background of the settlements, the hub provides story angles and questions for reporters to consider, as well as examples from reliable news sources for context.

Once an audience knows more about how opioid addictions and overdose deaths negatively impacted their community and how settlement spending plans aim to spur recovery, journalists can create community-specific settlement tracking tools that serve as a valuable public resource. The hub provides links for numerous ways to investigate and report on settlement spending.

Is it working? Journalists can help their audiences measure if opioid settlement plans and spending are slowing the opioid crisis within their communities. Stories that evaluate the results and how plans evolve will become increasingly crucial as programs are implemented and more data becomes available.

Quick hits: Fall leaf color predictions; Texas water crisis; rural movie for 2020 pandemic; opioid meds for jails

Map from SmokyMountains.com shows fall leaf color projections. Red indicates peak color. 

As autumn begins across much of the U.S., many Americans and tourists plan day trips or vacations to take in nature’s stunning fall colors. "Parts of the U.S. will soon start to see — if they haven't already — leaves and shrubs trade their green hues for vibrant shades of orange, yellow and red as the days get shorter and temperatures get chillier," reports Rachel Treisman of NPR. Explore Fall, TheSmokyMountains.com and Almanac websites offer some of the best "estimates [for] when leaves will change and colors will peak across the country."

Faced with ongoing population growth, an aging water system, and intermittent droughts paired with scorching temperatures, Texas officials and lawmakers are working to address the state's water crisis. But even as solutions are hammered out in Austin, the "state's regional diversity and patchwork of governments complicate matters further," reports The Texas Tribune. "Texas voters will be asked this fall to approve a $20 billion package to protect the state’s water supply. . . . The $20 billion is just a fraction of what some experts believe the state needs to invest going forward." 

In a bid to help balance pharmacy payments, Optum Rx "has increased reimbursement minimums for brand drugs for approximately 2,300 independent pharmacies," reports Heather Landi of Fierce Healthcare. The company's shift to a cost-based model is helping the bottom line of the "more than 24,000 independent and community pharmacies it works with. . ." More than half of all independent pharmacies operate in rural areas of the U.S., but many have closed or struggle to stay afloat due to high operational costs and low reimbursement rates.

When it comes to remembering 2020, many Americans would probably prefer not to recall the year at all. But film director Ari Aster doesn't want anyone to forget. In his latest film, "Eddington," Aster takes viewers back to the early days of the pandemic through the lens of a rural town drama set between a town sheriff and its mayor. Eddington captures the "anxiety, confusion, listlessness, and frustration of those first few months of lockdown as the backdrop for a dark and twisted story of a man, a town, and a country gone crazy," writes Anya Petrone Slepyan of The Daily Yonder. "Ari Aster’s latest rural thriller will give you something to think about."

When individuals suffering from opioid addictions are released from jail or prison, they face a high risk of overdose; however, a recent study shows that medication treatment during incarceration can lower their chances of overdosing upon release. "Use of medication for opioid use disorder (OUD) in jail was strongly associated with lower risks for overdose, death, and re-incarceration after release into the community," reports Shannon Firth of MedPage Today. The observational study was conducted in Massachusetts correctional facilities.

No matter where adults live, it may seem like kids have a different language that includes words that don't mean what they meant even three years ago. Keeping up with what young people are saying can feel impossible for anyone attempting to stay "hip," but not knowing kid-jargon can be a particular nightmare for parents. "As a little bit of an explainer, here’s a quick guide to slang terms that have made a mark in recent months," writes Paul Anthony Jones for Mental Floss. A few "explainers" are shared below.

Kid-jargon can mystify adults. (Graphic by Justin Dodd, Mental Floss)

W in the chat! "W has been used as a slang abbreviation for a win for over 50 years — although nowadays it’s used not just of victories, but of anything that could be regarded as laudable or impressive."

What the sigma?!? "As Merriam-Webster has noted, [the word] sigma has become increasingly ironic, pejorative, and jokey. . . This phrase in Gen Z and Gen Alpha vernacular is roughly the 2020s equivalent of 'What the heck?!'"

Do it for the plot! "If you imagine your life as one big movie, 'doing something for the plot' means doing something bold or risky that, in the retelling of your life story, would act as a major plot point."

Proposed $7 billion Purdue settlement advances; leaves Sacklers exposed

Adobe Stock photo

Since last July when the U.S. Supreme Court rejected the Purdue Pharma opioid bankruptcy agreement, negotiation has continued. The latest offer from the Sackler family may have enough support from stakeholders to stick.

"OxyContin maker Purdue Pharma’s latest plan to settle thousands of lawsuits over the toll of opioids could soon move forward after every U.S. state involved agreed to it," reports Geoff Mulvihill of The Associated Press. U.S. Bankruptcy Court Judge Sean Lane "is being asked to clear the way for local governments and individual victims to vote on it next."

If Lane moves the agreement forward, impacted parties have until Sept. 30 to vote "on whether to accept the deal, which calls for members of the Sackler family who own the company to pay up to $7 billion over 15 years," Mulvihill explains. Roughly $6.5 billion of the settlement will be taken from the Sackler's wealth, and "potentially more than $850 million would go directly to individual victims."

The biggest change the reworked plan offers is that it does not guard Sackler family members from civil liability suits related to the opioid crisis. Groups that reject this settlement can continue litigation against Sackler family members. Mulvihill adds, "Under the plan, the Sackler family members would give up ownership of Purdue."

The $7 billion the Sacklers have put on the table pales in comparison to their exposure. Mulvihill reports, "The settlement is a way to avoid trials with claims from states alone that total more than $2 trillion in damages. Thousands of local governments and other groups have also sued Purdue."

While the settlement is an attempt to hold the Sackler family accountable for its part in the prescription drug crisis, the family will remain exceptionally wealthy and will continue to run its global pharmaceutical company, Mundipharma, which operates in the United Kingdom, Canada, Germany and Singapore. 

Microgrant deadline extended for reporting on opioid settlement funds

Reporting on Addiction, a collaborative movement staffed by media professionals working to address addiction, is extending its deadline to apply for 2025 microgrants for journalists reporting on opioid settlement funds in Kentucky, Maine, New Jersey or New York.

June 20 is the new deadline. Apply here.

As billions in opioid settlement funds enter the U.S. economy, how that money will be spent is unclear. Especially for individuals, families and communities touched by the opioid and fentanyl crisis, having journalists who use their investigative skills to follow who spends the money and on what is of vital importance. Watchdog reporters are needed as a primary, trustworthy source for people who want to hold public officials accountable for how these funds are used to address the addiction crisis.

To support this vital journalistic effort, Open Society Foundations is partnering with Reporting on Addiction to offer four microgrants ($500–$1,000 each) for journalists reporting in Kentucky, Maine, New Jersey and New York to investigate how opioid settlement funds are being allocated and spent.

Grants will support long-term reporting that help your audience understand the opioid settlements and show them where and how funds are being spent. Priority will be given to submissions focused on:

• Spending (or a lack of spending) related to evidence-based prevention, addiction, harm reduction, treatment and/or recovery.
• Issues with waste, fraud, abuse, or mismanagement of opioid settlement funds.
• Incorporating the perspectives of impacted community members.
• Helping communities understand the spending decision-making process (or lack of process).

Story pitch requirements: Pitches can be for any platform, print, digital, radio, television, podcast, etc. Freelancer submissions are welcome, but must have a letter of support from a publisher.

Grant awardees will receive free training: Awardees must agree to attend two virtual Reporting on Addiction trainings, share their final story, and have a commitment from a newsroom editor to publish their reporting by Feb. 1, 2026. Freelancers should secure a publication commitment before applying and supply supporting documentation.

Report: The national cost of opioid use disorder is in the trillions of dollars each year, in addition to the suffering

Axios map, from Avalere Health data

As counties across the U.S. see many types of illicit drug deaths decrease, the country is left to grapple with the long trail of complex problems drug addictions cause, including their massive price tags.

A newly released in-depth analysis "concludes that it costs an average of nearly $700,000 to treat each affected person," reports Maya Goldman of Axios. "The cost burden falls unevenly, with states in a belt stretching through Appalachia to New England typically having bigger caseloads and a higher cost per case."

Although it's not possible to pin down the exact net dollars the country spent on opioid use disorder, the analysis from Avalere estimated 2024 costs at $4 trillion." The report's author, Margaret Scott, told Goldman, "While this is a cost to government, it's also a cost to private businesses, and the huge cost, of course, is to the individuals who have" opioid use disorder.

Comparing regional expenditures illustrates how extreme the costs for treatment can be. "The projected cost of opioid use disorder in 2024 ranged from $419,527 per case in Idaho to more than $2.4 million in D.C.," Goldman explains. "That covers lost productivity, health insurance costs, property lost to crime and other variables."

The economic losses from OUD are second only to the degree of human suffering individuals, families and friends have experienced by way of OUD trauma. Some of the sobering estimated and reported costs include:

• Economic burden on patients, including years of life lost and reduced quality of life, exceeded $3 trillion in 2024.
• Private businesses absorbed more than $467 billion in costs from lost productivity and health insurance costs.
• The federal government bore about $118 billion in Medicare and other federal insurance costs, lost taxes and criminal justice expenses.
• It cost state and local governments more than $94 billion, with about $42 billion going toward criminal justice costs.
• The Trump administration in March released its own analysis that estimated illicit opioids cost the U.S. about $2.7 trillion in 2023.

One way to reduce opioid treatment costs is to offer individuals the most effective treatment combinations possible. "Behavioral therapy alongside long-acting injectable buprenorphine — a treatment that reduces the risk of future overdoses — generated an estimated $295,000 savings per case, the biggest cost-saver of the options Avalere analyzed," Goldman reports. "Behavioral therapy alone saves a project $144,000 per case."

To use Axios' interactive state map of costs, click here.

A rural jail has success curbing opioid addictions: 'Jails are an incredible opportunity to help people enter recovery'

Alane O'Connor, DNP

Developing an effective and repeatable treatment for addiction sufferers has proven elusive -- until now. A rural jail in Maine has a solution that could save thousands of lives.

Addiction medicine specialist Alane O’Connor is leading a pilot program that "offers a monthly injection of the drug Sublocade to addicted inmates," reports Kristina Samulewski of The New York Times. The drug works through a time-release mechanism that curbs opioid cravings for a month. O'Connor presents her case for jails as drug recovery centers on the Times' podcast, "The Opinions." An edited synopsis of her discussion is shared below.

The state of Maine is overwhelmingly rural. It also has "one of the highest rates of opioid use disorder in the nation. And people who are incarcerated have an even higher rate, because often times the two go in tandem," O'Connor explains. "Jails are an incredible opportunity to help people enter recovery. It’s a time where motivation is often very high, but I think we don’t do a very good job, really, across the country in giving people access to the treatment that they need."

In response to the opioid epidemic's extreme reach in Maine, O'Connor suggested that Somerset County Jail try a different approach for treating inmates with opioid addictions. "I proposed an alternative medication, which I had been using in my community practice since 2017," O'Connor adds. "It’s not a pill. It’s actually an injection into the abdomen, and it’s called Sublocade."

Sublocade is gradually and continuously released into a recovering addict's system. Other opioid drug treatments can include daily methadone and/or Suboxone pills, which people can opt not to take. Sublocade does not offer a choice.

"If I have a patient that I’m prescribing Suboxone to and they don’t have that medication tomorrow or the next day, they are going to get very sick," O'Connor explains. "Sublocade slowly dissolves out of the system, and so patients will start to feel some symptoms after five or six weeks. But there isn’t this cliff that ends where people get very, very sick."

O'Connor says, "I’ve never, ever met anyone who said, I want to grow up and be addicted to drugs and end up in jail. It’s just not a reasonable thing to even think. And yet, I think society believes that patients can just make the choice to stop using tomorrow. And if they don’t have the appropriate medical treatment, that’s just a totally unreasonable expectation."

When Somerset County Jail's Sublocade treatment results were compared with another rural Maine jail where inmates received a daily pill of Suboxone, the results were striking. O'Connor notes, "We found that people treated with Sublocade were almost three times as likely to continue treatment when they leave the jail, relative to folks who were treated with the daily medication. . . . The most important finding was that we had no deaths in the people that were treated in the Sublocade pilot . . . In the comparison jail, unfortunately, there were four deaths."

A little-known pharmaceutical company that made billions selling opioids 'escapes' billions in fines and IRS payments

Endo began in 1920 as "Intravenous Products of America." Its website does not mention opioids;
instead it highlights the company's "past successes and history of expertise." (Endo photo)

A lesser-known pharmaceutical company named Endo made billions of dollars during the U.S. prescription opioid crisis by marketing its flagship opioid, Opana ER, as safe and non-addictive.

Despite whistleblower suits from Endo employees, the U.S. Department of Justice failed to pursue Endo, even as it vigorously prosecuted Purdue Pharma for its part in the opioid crisis, report Bob Fernandez of ProPublica and Craig R. McCoy of The Philadelphia Inquirer. The DOJ's investigative delay and the company's clever bankruptcy exit strategy allowed Endo to "escape $1.5 billion in fines and forfeitures" it owed and billions more "officials said it owed the U.S. government."

When the DOJ finally moved to prosecute Endo for its part in the opioid crisis, the company was bankrupt. "In what amounted to a liability fire sale by the Justice Department, the company’s woes with the federal government would all be resolved by a $200 million payment," Fernandez and McCoy explain. "In sentencing Endo in federal court Judge Linda Parker wondered how the amount paid to the U.S. could be so low. Parker said, 'I just don’t understand how it went from $1 billion to $200 million.' Federal prosecutor Benjamin Cornfeld explained: Endo was broke."

While Endo's 2024 financial troubles were real, a deeper look at the DOJ's delay after winning a criminal case against Endo in 2014, revealed how in those intervening years allowed Endo "vastly expanded its narcotic-pill empire before executing a corporate escape plan," Fernandez and McCoy write. "The plan allowed Endo to restructure its debt to retain control of the company and hand out $95 million in executive bonuses before seeking protection in bankruptcy."

DOJ's settlement with Endo concluded some of the company's financial troubles and "also mostly erased claims of another $1.5 billion for false health care billing and Medicare costs generated by the opioid crisis." In addition, "Endo paid a tiny fraction — three pennies on the dollar — of the $7 billion that officials said it owed the U.S. government, including $4 billion in taxes," Fernandez and McCoy explain. "Hundreds of lawyers, paralegals and financial advisers litigated Endo’s bankruptcy, billing more than $350 million. . . . Individual opioid victims didn’t fare as well. They got just $40 million from Endo — a sum that works out to about $1,000 per victim."

A glimmer of hope for U.S. overdose deaths: They are at their lowest levels since 2020, but officials warn to press on

A snapshot of overdose deaths from January 2015 to January 2024
(CDC graph, based on data available for analysis)

The U.S. opioid epidemic isn't over, but national totals for overdose deaths have declined for 12 months in a row, with current numbers "slowed to the lowest levels since 2020," reports Alexander Tin of CBS News. The decrease in deaths is attributed to several factors; however, experts warn that now is a time to "double down" on current efforts and keep looking for new ways to prevent drug abuse from starting.

American overdose deaths peaked in 2023, but the latest trend offers hope and some reassurance that current treatments are saving lives. "Around 70,655 deaths linked to opioids like heroin and fentanyl were reported for the year ending June 2024, the Centers for Disease Control and Prevention now estimates, falling 18% from the same time in 2023," Tin writes. "Almost all states, except for a handful in the West from Alaska through Nevada, are now seeing a significant decrease in overdose death rates."

In Appalachian states, such as West Virginia, where opioid addiction among residents was disproportionately high, overdose deaths have steadily declined with the rest of the nation. Emily Rice of West Virginia Public Radio reports, "A Sept. 1 analysis of provisional overdose death rate data from the CDC shows a rapid decrease in the number of drug overdose deaths in the U.S. and this time West Virginia appears to be keeping pace."

Even with good news, the current rates remain grim. Dr. Allison Arwady, head of the CDC's National Center for Injury Prevention and Control, told Tin, "We are encouraged by this data, but boy, it is time to double down on the things that we know are working. It is not a time to pull back, and I feel very strongly, and our data shows, that the threat continues to evolve." Brian Mann of NPR reports, "Roughly 100,000 deaths are still occurring per year. . .fentanyl, methamphetamines, xylazine and other synthetic chemicals are more poisonous than ever."

But the roughly 10.6 percent decline in overdose fatalities still speaks to some success. Tin writes, "Arwady pointed to a long list of factors that officials hope are contributing to the decline, ranging from broader availability of the overdose-reversing spray naloxone, also known as Narcan, to efforts to ease gaps in access to medications that can treat opioid use disorder."

Youth education programs may be contributing to the decline. Tin explains, "Trends in what health officials call 'primary prevention' have also improved in recent years — meaning fewer people using the drugs to begin with. As an example, Arwady cited CDC surveys showing a clear decline in high school students reporting that they have tried illegal drugs."

A simpler assessment tool for newborns exposed to opioids means more mom time and fewer medications

Cailyn Morreale continued using buprenorphine during her pregnancy. Once her baby was born, the two were never separated. (Photo by Taylor Sisk, KFF Health News)

A new approach is helping mothers recovering from opioid addiction and newborns with opioid exposure stay together after birth. Historically, babies born with opioid exposure have been separated from their mothers and received heavy medications in neuro-intensive units, but "research has since indicated that in many, if not most, cases, those extreme measures are unnecessary," reports Taylor Sisk of KFF Health News. "A newer, simpler approach that prioritizes keeping babies with their families called Eat, Sleep, Console is being increasingly embraced."

Over the past decade, how pregnancy pairs with addiction treatment has changed, meaning most women can continue to take addiction-recovery medication throughout pregnancy. For Cailyn Morreale, a West Virginian from rural Mars Hill, the new methods helped her continue her recovery medicine, buprenorphine, and her care team assured her "that her baby would be assessed and monitored using the Eat, Sleep, Console approach," Sisk explains. "Morreale was never separated from her son. She was able to begin breastfeeding immediately. She was told, the trace of buprenorphine in her breast milk would help her son withdraw from it."

The Eat, Sleep, Console method is slowly replacing the older Finnegan Neonatal Abstinence Scoring System, which involved 21 evaluative questions. Sisk writes, "David Baltierra, former director of West Virginia University’s Rural Family Medicine Residency Program, chair of WVU’s Department of Family Medicine, suggests this protocol could simply be called 'parenting.' Baltierra and his colleagues have been training residents to use an Eat, Sleep, Console approach for a decade. . . .The results are persuading more health professionals to adopt the method."

A 2023 study found "babies treated this way were discharged from the hospital in nearly half the time and less likely to receive medication than those receiving Finnegan-based care," Sisk reports. "Matthew Grossman, an associate professor of pediatrics at the Yale School of Medicine, found a non-pharmacological-first approach works best. He said the Finnegan tool is useful but often too rigid. Under its scoring, one sneeze too many could send a baby to the NICU for weeks."

Research by Leila Elder and Madison Humerick, who each did their residency in WVU’s rural program, "found that median stays for newborns in withdrawal dropped from 13 days in 2016 to three in 2020," Sisk adds. "The simpler treatment also means more babies born in rural communities can receive care closer to home and has reduced the likelihood a mother will be released before her baby is cleared to go home."

A young farmer and former addict offers hope for recovery: 'The only thing you’re not coming back from is death.'

Nathan Caburn, a successful Mississippi Delta farmer
and past opioid addict. (Photo by C. Bennett, Farm Journal)

Nathan Casburn could be a poster child for a drug-addicted prodigal son, who threw away his farm and family for oxycontin and heroin highs.

Casburn's story is a tale that resonates with opioid-ravaged families and reflects what the love of a father and the support of a rural community can do for addicts who want to go home and begin again, writes Chris Bennett of Farm Journal. "Casburn is a most unlikely survivor. He tells a hellish tale of loss and triumph on the farm — without a shred of blame cast beyond his own shadow."

As a teenager, Casburn obsessively played video games. He told Bennett, "I played every waking moment I could, to the point of fixation. I knew I was different from the other kids and not in a good way; I was geared toward escapes. In my case, an obsession with video games was a symptom of my unhealthy mindset.”

From video game escapes, Casburn went on to alcohol. Bennett writes, "In 2004, on backroad gravel, Casburn, a high school junior, broke two vertebrates in an alcohol-related car crash. The subsequent pain management became a party, legitimized by medical approval in the age of OxyContin. Casburn was in love. Welcome to the wonder world of opioids."

Casner wanted nothing to do with his family's Mississippi Delta farm in Tallahatchie County. He was all about the highs. "Next stop, 75 miles west to Ole Miss and Oxford, and a chain of descent in a college town: DUI’s, car wrecks, arrests, hospitalization, overdoses, academic probation, and legal woes," Bennett explains. "By 2014, with no job, no degree, and no prospects. . . . OxyContin and other legal pharmaceuticals were out of his price range. He responded with the most hellish economic decision of his life. Go home to the farm and tap the vein. Heroin."

"Rain or shine, addiction woke Casburn at dawn every day, demanding a morning fix," Bennett writes. "In 2017, at 29, Casburn’s body gave out. After two weeks in intensive care due to a heart valve infection derived from heroin use, he returned home, and checked into rehab. . . . Three weeks after rehab, Casburn was back on the needle."

Then death came knocking. Casburn told Bennett: "I had an out-of-body experience with no drugs involved. I saw everyone going on with life, and me stuck right there dying as an addict. Right then, in the library, I dropped to my knees and threw up a prayer in desperation, but I meant every word. I called out to God for mercy and forgiveness. I told Him that if He would help me, then I’d do everything He asked. That prayer was answered.”

He told Bennett, “All the people around me in our farming community came to help me in one way or another." Bennett adds, "Seven years after crashing to his knees, Casburn has earned a stellar reputation and built a thriving farm life. . . . In March 2024, he and his wife Caitlin were blessed with a baby girl — Nora." He is grateful for a "particularly stalwart source of support — his father, Rea."

Casburn wants people who are addicted to know there is always hope. He told Bennett, "Never, never believe that you can’t get out of drugs. You’re never too far gone. The only thing you’re not coming back from is death.”

Quick hits: Trucks for farmers; guide for emergency alerts; Native Americans enter elections; PORKtober is here!

AGwagon kits make trucks tough enough for farming.
(Photo by Matthew J. Grassi, Farm Journal)

Farmers who want a truck built for the rigors of farming can now make one with "AGwagon," aftermarket kits, reports Matthew J. Grassi of Farm Journal. "There has never been a pickup truck 100% purposely built for farmers and ranchers. . . . The kits convert off-the-factory-line trucks into rugged and tough, back 40 devouring, farm equipment hauling beasts. . . . The AGwagon kits were built off feedback from a panel of 14 farmers and ranchers."

Signing up for emergency alerts may sound simple, but often it's not. This group made an emergency alert guide that can be a model for other communities, reports Natasha Uzcátegui-Liggett of CalMatters. "If you’re interested in publishing a comprehensive emergency alert guide for your state, you can start with our article on CalMatters (it’s free to republish if you credit us clearly, and the majority of it applies to all states), and then swap out the section titled 'How to sign up for your county’s alerts' with your reporting for your state. . . "

Humans and other animals have more than one 'prong' of defense against germs.
(Knowable graphic)

Immune systems are part of living creatures' defenses against bacteria and viruses, but they aren't the only type of protection. "Some scientists think we should devote more attention to a second prong of defense: one that allows our bodies to more harmlessly live with pathogens until they’re cleared from our systems," reports Liam Drew of Knowable. "There is a substantial body of research showing various ways in which animals can tolerate, and so survive, maladies such as malaria, sepsis and dysentery."

Dr. Stephen Loyd

He was a physician, then an opioid addict, and now he's West Virginia's "drug czar," reports Leah Willingham of The Associated Press. "Dr. Stephen Loyd, who has been treating patients with substance use disorder since he got sober two decades ago, says combating opioid addiction in the state with the highest rate of overdose deaths isn’t just his job. It’s an integral part of his healing. . . . Loyd says he is ready to help advise the state's foundation on how to distribute the nearly $1 billion in settlement money saying the state has a 'moral and ethical responsibility' to spend it wisely."

Amid election year tensions and negativity, there are some bright spots. This November, "a record-breaking number of Native Americans are running for state and local office," reports Daniel C. Volk of Route Fifty. "Advance Native Political Leadership, a group that works to increase Native American representation at those levels of government, says there are 230 Native candidates running across the country this year, up from 100 when it first started counting in 2016. About 80% of this year’s candidates are women."

Deanne Frieders

It's PORKtober, and "This Farm Girl Cooks" web writer Deanne Frieders can help you decide "what's for dinner," even if you're delivering supper to a field of workers, reports Jennifer Shike of Farm Journal. "As a cook, she loves how versatile pork is to cook with as it can take on so many flavor profiles from Italian to Tex-Mex to Asian." To explore Frieders' website full of farmer-friendly meals, click here.

PFAS, also known as "forever chemicals," can cause devastating health issues for humans, partially because they build up in the body over time. Much of the concern over PFAS has been their "everlasting" presence in U.S. water supplies, but this town has succeeded in removing them, reports Pien Huang of NPR. "Yorba Linda is a small, sunny city southeast of Los Angeles. It’s home to the nation’s largest per- and polyfluoroalkyl (PFAS) water treatment plant of its kind." The plant can serve as a model for other communities.

Opinion: Understanding how fentanyl 'saturated the U.S. drug supply' could help address the addiction crisis

Naloxone can prevent overdose deaths, but it's expensive.
(Adobe Stock photo)

The current U.S. opioid crisis started with painkiller prescriptions in the early 2000s, but once medical providers started nixing those medicines, heroin's popularity surged, and then fentanyl and its "tsunami" of death entered the market, reports Maia Szalavitz of The New York Times. "Understanding how fentanyl saturated the drug supply, moving from the East Coast of the U.S. to the West, is critical to ending the worst drug crisis in American history."

Drug cartels' greed drove the creation and use of fentanyl. "By 2013, cartels had realized that they could slash their labor, manufacturing and transit costs by replacing heroin derived from farm-grown opium with a powder made in a lab — fentanyl," Szalavitz writes. "Before 2018, 80% of all deaths associated with fentanyl occurred east of the Mississippi. . . . Since 2021, at least two-thirds of America’s 100,000 annual overdose deaths involved a synthetic opioid like fentanyl."

While heroin was considered a more urban drug, "increased opioid prescriptions — followed by sharp reductions — resulted in new heroin users in rural areas," Szalavitz explains. "Illegally manufactured fentanyl began appearing in both urban and rural drug markets. . . . Rural West Virginia and other Appalachian regions were the center of the earliest prescription opioid wave of the crisis, which led to the establishment of new heroin markets in places facing job loss."

Combating opioid addiction and overdose deaths liked to fentanyl is tough because the drug's supply chain and use is now deeply embedded across the country. The drug is cheap to make and buy, and provides an exceedingly potent high for the user. "So, what can be done? The answer is to focus on the drivers of demand, not supply. This means addressing the roots of addiction and treating it compassionately," Szalavitz writes. "We have a great generic opioid overdose antidote, naloxone. . . . And two medications — methadone and buprenorphine — have proved to cut the risk of death among people with opioid addictions by 50% or more when used long-term."

Szalavitz adds that people often start doing drugs because their lives feel hopeless. "Addiction is most often an attempt to escape despair. The condition itself is defined by compulsive drug use despite negative consequences, which is why threats of punishment or even death rarely yield recovery. . . . It’s not coincidental that the exponential rise in overdose deaths has occurred in tandem with a profound increase in income inequality."

Rural jail offers newly released prisoners with addiction disorders a long-lasting drug to prevent relapse

Cost is a major barrier to using Sublocade as an
addiction treatment for prisoners. (Adobe Stock photo)

In rural Maine, a county jail began giving a long-lasting form of buprenorphine to inmates with drug addictions before they left incarceration. The medicine, which curbs opioid cravings for 28 days, helps past inmates avoid "withdrawal, relapse and overdose — dangers that newly released prisoners confront nationwide," reports Jan Hoffman of The New York Times.

Once out of jail, addiction sufferers can face several obstacles to staying in recovery while re-entering their communities. Maine's Somerset County sheriff, Dale P. Lancaster, was discouraged by the number of inmates who would leave prison and die from overdoses. Lancaster pushed for the extended-release medical treatment. Hoffman writes, "According to a recent analysis in Health and Justice, the switch had a remarkable effect. The long-acting injection afforded newly released prisoners a crucial buffer period after they were discharged, with more time to set up continuing addiction treatment and stabilize their lives."

People suffering from drug addictions are more likely to end up on the wrong end of the judicial system. "Of the more than 1.2 million prisoners in the United States, up to 65 percent of prisoners have active substance use disorders, according to some studies," Hoffman explains. And while those institutions have an opportunity to treat the addicted, few have the resources or staffing. In the case of extended-release shots of buprenorphine, known as Sublocade, the treatment's cost remains a big barrier, with the list price for a monthly injection about $2,000, while a month's supply of pills ranges from $90 to $360.

But the success of Maine's program may help turn the tide. "After being released, the Somerset County prisoners who got the shot were three times as likely to continue treatment as those at another rural Maine jail who received the daily pills" [which are discontinued upon release], Hoffman adds. "Between September 2022 and September 2023, three prisoners from the jail where the pills were dispensed died from overdoses within three months of being released; a fourth died by suicide. None of the former Somerset prisoners who had received the injections died."

Dr. Alane O’Connor, co-chair of Maine's Opioid Response Clinical Advisory Committee, said that "as word of the Somerset program spreads, she is getting inquiries from other county sheriffs about how to bring the shots on board," Hoffman reports. "She is also hearing from former prisoners." O'Connor told Hoffman, "Many wanted to stay on the shots, so they would come back to the jail asking our help in finding a provider."

Some U.S. lawmakers want to change methadone treatment availability, but their plan's success seems unlikely

When it comes to substance abuse disorder, perhaps
there is 'no cure.' (Adobe Stock photo)

Solving the U.S. fentanyl overdose crisis has led to political discussions about decreasing methadone treatment restrictions. A recent proposal by a bipartisan group of U.S. senators seeks to save lives by "allowing addiction specialists to prescribe [methadone] outside of the clinics now permitted to dispense it," reports Carmen Paun of Politico. But the bill faces opposition from methadone clinic directors who maintain "that allowing prescribing outside of clinics is risky without their strict safeguards. Methadone is an addictive opioid that’s deadly if abused."

If passed, the bill "would reshape not only how methadone is prescribed but also dispensed — patients could pick up their prescription at the pharmacy," Paun explains. "Now, most have to go in person every day to a clinic to receive their dose under supervision." The additional time and expense of daily travel to and from treatment clinics can make recovery more difficult.

Conflicts over methadone are like a catch-22: "Proponents of making methadone easier to get say that [fentanly's death] toll is ample reason to rethink treatment rules that are now decades old," Paun reports. "The clinics fear it’s a bad idea that could make the overdose problem worse. Thus far, they’re winning the debate in the only forum that matters: Congress."

As the legislation stands now, it is not likely to become law, but the opioid problem remains. "The clinics have succeeded in convincing enough Republicans that expanded access comes with significant risks," Paun writes. "Advocates of broader prescribing say the clinics are more interested in protecting their turf than in saving lives. . . "

Even if methadone could be dispensed through the pharmacy model, the drug isn't a panacea. "Many of those who start methadone treatment drop out within the first year," Paun reports. "Only 34% of a sample of 39,000 patients at BayMark Health Services, one of the nation’s largest methadone treatment providers, were still in treatment one year after they started . . .The reality of opioid use disorder is that, for many, there is no cure, experts in the condition say. Rather, it’s a chronic condition needing lifelong medication and management."

Appalachian program helps people in recovery find a new life in construction work

Lindsey King works on a new home.
(Photo by J. Glendenning, IRJ)

Lindsey King is rebuilding her life by building homes in Kentucky. Her new career is a testament to a successful trifecta of efforts from the Hazard-based Housing Development Alliance's Hope Building Program, the Perry County Drug Recovery Court, and King's determination, reports Jenni Glendenning of the Institute for Rural Journalism. King will celebrate four years of recovery on Aug. 18.

Like many people in recovery circles, King experienced a "moment of clarity" when she "was only able to see her children once during her six-month stay," Glendenning writes. "She praised Perry Circuit Judge Alison Wells, who sent her to treatment after her arrest. King told Glendenning, “She seen things in me far before I’ve seen them in myself, and she pushed me to get there.”

King attributes part of her ongoing successful recovery to community support. She told Glendenning, "There’s no stigma over recovery anymore around here." Glendenning writes, "When King entered the Hope Building Program as a trainee, she and her children, now 8 and 7, lived in a one-bedroom apartment with one twin bed and a small closet. She moved up to a two-bedroom apartment and now owns her own home, where they all have a bedroom, and the kids have a place to play outside."

King likened recovery to building a home, which starts with a solid foundation and goes up from there. "She knew she wanted to be a carpenter after about a month of being involved in the Hope Building Program, even though she had never done construction," Glendenning explains. "King said that she has not been treated differently on the job because she was a woman. . . . Her advice for women looking to enter the trade is, 'Even if it’s something you think you can’t do, do it, go for it!'"

To become a carpenter, King attended Hazard Community and Technical College and "is the first person in her immediate family to attend college," Glendenning reports. "After King completed the program, the HDA hired her as a temporary assistant trainer for a year. Now she is a full-time assistant to lead trainer Josh Boyd; they work with a crew of four in the program."

King with her children, Waylon and Iris
(Photo by J. Glendenning, IRJ)

The Hope Building Program is primarily funded by the Appalachian Regional Commission’s Just Transition Fund for coal counties. "It aims to increase the long-term success rates of people in recovery while also rebuilding the local housing market," Glendenning writes. Shannon Gabbard, who runs the Hope Building Program, told Glendenning, “Ultimately, our goal is to help them transition into the workforce full-time. They must consistently pass random drug screenings, and the feedback we can provide helps to ease the minds of employers who may otherwise hesitate to hire employees who are in recovery.”

A criminal record can make it hard for people in recovery to find employers willing to give them a chance. Glendenning explains, "The Hope Building program does a background check, but Gabbard tells trainees, 'I don’t want them to stress about it because we haven’t seen anything yet that we haven’t been able to work through.' This offers a sense of relief, but once they are hired, 'they cannot have any new criminal charges after they begin the program.'"

Mindy Miller, HDA’s director of development and communications, whose own family has seen hardship from the drug epidemic, told Glendenning, “It's stories like Lindsey’s that give people hope. Her story is a lighthouse, a beacon shining in the night for every addict and for every person out there who loves an addict." Glendenning adds, "King considers the folks at the HDA her family and loves knowing that through her work she is giving back to her community by building something that is going to be someone’s home."

Drug-use stigma among addiction treatment providers is a barrier to care; state policymakers can help create change

Many substance abuse disorder providers have stigmas
about drug use. (Photo by V.  Hryshchenko, Unsplash)

Even though many addiction treatment centers encourage participants to talk openly about their opioid or substance-use disorder, many patients encounter medical providers with drug-use stigmas, which present an obstacle to care, reports Kaitlyn Levinson of Route Fifty. Some state governments can use policy changes to help remove social stigmas as a barrier to addiction treatment.

Noa Krawczyk, an assistant professor at New York University, told Levinson, "At the individual level of a person choosing not to use those treatments because of negative perceptions around them, to the policies that regulate these treatments [and] to the protocols that exist in treatment programs for how these medications are delivered. . . .[Stigma is] ingrained in every single aspect of these treatments and plays a huge role as in terms of a barrier to care.”

Even when opioid treatment is available and affordable, facing a biased medical community can mean a substance disorder patient opts out of recovery treatment. "A recent analysis from The Pew Charitable Trusts suggests normalizing methadone treatment could help expand its accessibility," Levinson writes. "Some states are moving to align their methadone-related regulations to mirror the federal government’s efforts, including California where policymakers are considering a bill that would allow doctors — not just methadone clinics — to prescribe take-home doses of the medicine."

Making treatment more accepted and widely available may address some stigmas, but changing policy goals and language can also help shift attitudes.

Massachusetts policymakers are working to remove drug-use stigma dynamics when a newborn tests positive for drug dependency. "Under current law, hospital workers are required to notify state officials about babies whose blood tests indicate substance use from their parent," Levinson reports. "The new policy would only mandate such reporting if the infant was at imminent risk of abuse or neglect, WBUR reported. The bill also directs health officials to establish a plan for new parents managing their substance use disorder."

Addiction workers need to thoroughly understand addiction as a medical problem or many treatment facilities will fail to help patients. Frances McGaffey, associate manager of Pew’s substance use prevention and treatment initiative, told Levinson, "[Otherwise] there is a mismatch between the community the provider aims to serve and the population actually getting care."

Supreme Court blocks Purdue Pharma opioid settlement; agreement 'broke a basic tenet of bankruptcy law'

OxyContin's success made the Sacklers billionaires
and sparked the U.S. opioid crisis. (A.S. photo)

The U.S. Supreme Court rejected the Purdue Pharma opioid bankruptcy agreement that would have safeguarded Sackler family members from civil liability suits related to the opioid crisis.

"In a 5-to-4 decision, the justices found that the deal, carefully negotiated over years with states, tribes, local governments and individuals, had broken a basic tenet of bankruptcy law by shielding members of the Sackler family from lawsuits without the consent of those who might sue," reports Abbie Van Sickle of the New York Times. Purdue Pharma, which was owned by the Sackler family who developed and marketed the prescription painkiller OxyContin, is "largely considered to have ignited the [opioid] crisis."

Meanwhile, there are more than 100,000 opioid victim families waiting for financial restitution from Purdue Pharma. For some, the ruling is considered a setback. Other family members welcomed the decision. Van Sickle writes, "Although most creditors who voted on the proposed plan supported it, Justice Gorsuch wrote, 'fewer than 20 percent of eligible creditors participated' and 'thousands of opioid victims voted against the plan, too, and many pleaded with the bankruptcy court not to wipe out their claims against the Sacklers without their consent.'"

As Van Sickle reports, the court's majority "homed in on the method the Sacklers used to insulate themselves from opioid-related lawsuits, finding that a third party could not use the bankruptcy system to shield themselves from litigation, binding others without their consent. . . . This approach, Justice Gorsuch wrote, allowed them to win relief 'without securing the consent of those affected or placing anything approaching their total assets on the table for their creditors.'"

The proposed deal would have required the Sacklers to pay up to $6 billion over 18 years, but its building blocks demonstrate the tightrope negotiators are trying to walk between getting family members, states and tribes money now, even if the agreement shielded the Sacklers' personal wealth. "In a strongly worded dissent, Justice Brett M. Kavanaugh, "warned of the consequences for the tens of thousands of families seeking compensation," Van Sickle reports. "Justice Kavanaugh wrote that upending the settlement to prevent the Sacklers from escaping future litigation would only add to the pain of opioid victims and their families."

Within the deal's bankruptcy reorganization, Purdue Pharma "would become a 'public benefit' company with a mission focused on opioid education and abatement," Van Sickle reports. "The company, with the help of the Sacklers’ planned contributions, offered individual victims payments from a base amount of $3,500 up to a ceiling of $48,000." Purdue Pharma has committed to working toward a new settlement deal.

'On the Front Porch' is hosting an expert-led discussion on July 8 about the opioid crisis in rural America

Tony Pipa and Brent Orrell are back "On the Front Porch" hosting rural-focused conversations starting on Monday, July 8, from 12:45 to 1:45 p.m. E.T.

Their July 8 event will include insights from Keith Humphreys, a professor at Stanford University, and Sally Satel, senior fellow at the American Enterprise Institute, both of whom are experts on opioid use disorder and its impact on rural communities. Their discussion will look at the causes of and potential solutions to the nation’s drug epidemic, especially as that challenge presents in nonmetropolitan areas.

Register here. If you have missed previous On the Front Porch conversations, you can find them here.

In other rural news, the second season of Pipa's Reimagine Rural podcast continues with new episodes every three weeks this summer. The most recent episode explores Licking County, OH, the future home of Intel’s two new semiconductor factories, which is the largest private sector investment in Ohio’s history. Pipa speaks with elected leaders of nearby jurisdictions about the inevitable changes they face and the collective planning process they developed to protect the integrity of their towns after being left out of the siting decision. You can listen to that episode here or on your favorite podcast platform.

Past episodes, including all of season 1 and the first three episodes of season 2, can be found here.