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."

W.Va. local governments get 24.5% of opioid settlement funds, but the oversight and how the funds are spent varies

Graph by Hannah Heiskell, data from West Virginia First Memorandum of Understanding 

In 2021, West Virginia lost more than one thousand residents due to opioid overdose deaths. Between 2021 and 2024, the state ramped up its prevention and treatment efforts, some of which now benefit from opioid settlement dollars. As investigative student reporters from West Virginia University’s Reed School of Media discovered, how those funds are spent varies widely throughout the state.

"West Virginia will receive about $980 million from the settlement, split into payments over 18 years," reports Hannah Heiskell for Mountain State Spotlight. "The West Virginia First Foundation – a nonprofit created by the state Legislature – will control the spending of 72.5% of the funds, local governments 24.5%, and the West Virginia Attorney General’s Office 3%."

How local governments spend their chunk of settlement funds is limited by state guidance, but includes "increasing access to treatment or prevention-education programs."

With those constraints in mind, WVU student reporters looked at "how local governments oversee that money, including the process through which they take applications, make awards and account for spending," Heiskell explains. Since each local government can make its own decisions, "oversight and accountability built into local spending can be markedly inconsistent from county to county – with some doing very little to collect the advice and opinions of addiction experts or people with lived experience."

Local funding is often decided by county commissioners, who are not subject to the oversight by the West Virginia First Foundation. "While county commissioners are not required to have expertise in substance use disorders or follow a specific application, review, or awarding process, Laura Lander, addiction therapist and associate professor at West Virginia University’s Rockefeller Neuroscience Institute, said this thinking confused her," Heiskell reports.

"Without input from external sources and stakeholders, Lander said funding awards are subject to a commissioner’s individual bias," Heiskell writes. Lander told her, "Clearly, in other counties, based on what I’ve seen, the money used for law enforcement has the county commissioner’s ear, and we see lots of money going towards police vehicles."

Kanawha County Commission has opted to share some details by "posting all applications to their website for the public and other organizations to review," Haskell writes. "In contrast to many counties in the state, the Preston County Commission has taken a more deliberate approach to its spending. . . . It's one settlement and 55 systems."

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.

Fentanyl imports saturate U.S. illicit drug market. U.S. tariffs aim to curb its transit as fentanyl continues to kill.

The global drug problem has ended countless lives.
(Unsplash image)

More than 70% of drug overdose deaths are due to opioids, with fentanyl as the main assailant. From August 2023 to 2024, 89,740 people died from overdoses in the United States. This number is 22% less than than the year prior, according to Centers for Disease Control and Prevention projections.

Fentanyl is a synthetic opioid that is up to 100 times stronger than other opioids like morphine, heroin or oxycodone. Its main use, as approved by the Food and Drug Administration, is as a pain reliever. Often fentanyl is mixed into other drugs as a cheap way to make them stronger. According to José de Córdoba, Vipal Monga, Julie Wernau and Brian Spegele of the Wall Street Journal, “The drug is cheap to make, provides huge profit margins and is easy to smuggle.”

“President Trump has declared that the illegal transit into the U.S. of migrants and drugs, chiefly fentanyl, is a national emergency, and he has targeted Mexico, Canada and China with tariffs to force them to halt the flow,” reports the Journal.

According to the Journal, Canada responded to the fentanyl problem in 2024, saying that it would invest "$900 million over six years to improve security." China cracked down on the production and sale of fentanyl in 2019, however it continues "to produce the chemical ingredients used to make fentanyl and to sell them to drug producers in Mexico, the U.S. and elsewhere.” Mexico also said that it would increase border security to focus on preventing drugs from crossing the border.

Mexico President Claudia Sheinbaum, “whose top security concern is a war between two factions of the Sinaloa cartel, said she asked for Trump’s help in stopping the smuggling of weapons to Mexico that end up in the hands of cartels,” reports the Journal.

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."