Rural Communities and the Fentanyl and Opioid Addiction Crisis

Overview of the Opioid Crisis 

The sharp rise in the number of Americans addicted to opioids in the 2010s is referred to as the “opioid crisis.”

It began with the introduction of new painkillers in the 1990s that, despite claims by pharmaceutical companies, proved to be highly addictive, resulting in rapidly increasing rates of patient abuse and addiction.

Despite being comparable to illegal drugs, these medications’ side effects have frequently been underestimated because they have been approved for medical use. The rapid rate of abuse and addiction has been facilitated by pharmaceutical companies’ and health care providers’ negligence as well as a lack of education and public awareness.

Fifteen out of every 100 Americans live in rural areas. Rural drug overdose mortality rates have surpassed urban ones, posing a significant threat to public health. 

Three waves to the opioid overdose crisis:

1. Increases in deaths involving prescription opioids started in 1999
2. Increases in heroin-related deaths started in 2010
3. Since 2013, there have been more deaths involving synthetic opioids such as fentanyl

Fentanyl and Opioid Addiction in Small Towns and Rural Communities

Experts in the countryside point out that, despite the fact that opioid-related deaths do not surpass those caused by alcoholism or suicide, the rate of increase in these deaths are a major cause of concern. Data showed a prevalence rate of 325 percent compared to a 198% increase in urban areas between 1999 – 2015. 

How did this happen? Well, the opioid crisis is a perfect storm for a culture that marks time by seasons.
Some people speculate that the 2007 recession played a major role and that many rural areas have yet to recover.

It has been virtually impossible to improve living conditions due to unemployment, declining incomes, the closing of businesses, and a decrease in community resources. Substance abuse is frequently brought on in large part by anxiety, stress and emotional anguish regarding living conditions and financial security.

Economic Impact

The Great Recession, which started in 2007, is most certainly a part of the problem. The unemployment rate in these towns has decreased significantly over the past ten years as well and has not yet recovered.

Family-owned businesses are slowly disappearing and the chance to make a living has been replaced by few, low-paying service jobs. Opioids that are readily available have evolved into “drugs of solace” that cover up physical and emotional pain in a world where there is little hope for improvement.

Impacts on the economy include lower wages and overburdened healthcare systems. A lot of people in rural areas work in mining, manufacturing and agriculture, all of which frequently cause them to suffer from long-term injuries or pain.

These jobs are physically strenuous and often risky. As a result, injuries and chronic pain are more common and many people have come to rely on opioid painkillers just to keep working and functioning.

The cost of taking time off work to heal is also high. What initially appears to be a legitimate prescription for pain can quickly result in an opioid addiction.

Physical and occupational therapy are limited treatments for chronic pain and doctors in rural areas are frequently overworked. Some claim that opioid prescriptions started an addiction for some patients and became the go-to medication for rural doctors.

 
Social Impacts

The support networks and social lives within a small town are woven together by family ties, family life and community ties. Work is hard, people look each other in the eye and they know each other’s business.

The foundation of these social and kinship networks is mutual trust and cooperation. Therefore, it is not uncommon for workers who sustain an injury on the job and receive an opioid prescription to then share or sell the prescriptions to friends and neighbors.

Patients in rural communities face a number of obstacles, including stigma and judgment, a lack of local treatment facilities, a lack of health insurance and not knowing what pain-management questions to ask a doctor.

Social impact, such as family breakup and decreased quality of life exists. Services for comprehensive substance abuse treatment are scarce or absent most of the time in these depressed communities.
A lack of health and social service infrastructure is caused by a lack of resources and funding.

Inadequate supply of mental health professionals and evidence-based treatments like Medication Assisted Treatment (MAT) and support services for long-term recovery only serve to fail these vulnerable populations.

Patients have to travel a great distance to get the care they need because there aren’t any treatment services nearby. It has been demonstrated that lower completion rates of substance abuse treatment programs are frequently observed when patients are required to travel considerable distances to receive treatment. Finding a way to remove these obstacles to treatment so that these rural communities can regain their strength is the most difficult challenge.

Solutions for Rural Communities

Improvements in public health programs can reduce the number of overdose deaths in rural America. 

Teaching healthcare professionals how to treat patients with opioid use disorder (addiction) and safer ways to prescribe opioids is essential as well as taking into account non-opioid pain management options like exercise and physical therapy, cognitive behavioral therapy and using pain medications like naproxen, acetaminophen and ibuprofen.

Some of these alternatives may actually be more effective than opioids and have fewer risks and side effects:

1. Providing high-risk individuals, their families, emergency responders and law enforcement with access to naloxone, a drug that can quickly stop an opioid overdose and supporting training on how to use it
2. Working with public safety to share data, scale up evidence-based strategies and reduce the supply of illicit drugs
3. Increasing access to treatment for opioid use disorder through medication-assisted treatment or comprehensive services to reduce infections from injection drug use, such as HIV or Hepatitis C

Increased Access to Treatment  in Rural Areas

What Is Medication-Assisted Treatment (MAT)?

Like diabetes, which is a chronic disease of the pancreas, opioid use disorder (OUD) is a complex brain disease. Insulin is the treatment for diabetes and there are medications available for OUD treatment which is highly effective in:

• reducing HIV transmission
• increasing treatment retention
• reducing illicit drug use and overdose deaths 

The three medications used to treat OUD are:

1. methadone
2. buprenorphine
3. naltrexone

These treatments, according to experts, can block the effects of opioids in the brain either partially or completely and aim to ensure that the patient feels normal and experiences few or no side effects or withdrawal symptoms and has regulated cravings.

MAT includes more than just drugs and should to be used in combination with counseling and behavioral therapies to provide a whole-patient approach to the treatment of substance use disorders. 

Education Initiatives 

Campaigns for public education and awareness are crucial to the fight against addiction. To prevent or reduce substance abuse and overdose deaths, these campaigns provide community members with tools and information about the risks of prescription and illicit opioids, substance abuse, and treatment options.

Community education can also assist in dispelling common misconceptions about substance abuse and misuse, which perpetuate stigma and discourage treatment seeking.

A variety of media, including billboards and print ads, digital banner ads and websites, television and radio public service announcements, social media, brochures, and posters, are used in campaigns to target specific audiences (such as teenagers or older adults).

Syringe / Needle Exchange Programs

In 1988, Tacoma, Washington, became the site of the first needle exchange program. There are now nearly 200 across the nation. 

The idea behind needle exchange programs is to reduce harm. In order to stop the spread of infectious diseases like hepatitis and HIV, they give clean needles to people who inject drugs.

An estimated 50% decrease in HIV and HCV incidence is linked to SSPs. HCV and HIV transmission are reduced by more than two thirds when combined with medications that treat opioid dependence.

Syringe Services Programs (SSPs) are an efficient component of comprehensive community-based prevention programs that provide additional services and reduce HIV and HCV infections. 

As the use of injection drugs has increased in small towns, attitudes toward needle exchange programs have changed, even in conservative communities. Needle exchanges are now more common in rural areas of West Virginia and Tennessee than they were in big cities like New York or Philadelphia.

Naloxone Distribution

When administered intramuscularly or intranasally, naloxone reverses an opioid overdose. However, naloxone must be available at the time of overdose for it to be effective.

When first responders are unavailable or when witnesses to overdoses are unwilling or unable to call 911, distribution of naloxone to laypeople can save a life. Naloxone is becoming more and more readily available through standing orders at some pharmacies; However, even when options are available, stigma and cost persist. 

There are two main ways that laypeople can get Naloxone:

1. as part of overdose education and naloxone distribution (OEND) programs for people at risk of overdosing (as well as those in their social networks)
2. pharmacies

Syringe exchange programs, homeless shelters, emergency medical services, social service agencies, libraries, emergency departments, health care providers and substance abuse treatment programs are just a few of the many organizations that participate in OEND efforts.

Out-of-pocket costs, pharmacy availability and consumer acceptance vary by jurisdiction. The FDA is looking into making some naloxone products available over-the-counter (OTC).

Safe Disposal Sites

It’s important to dispose of needles correctly. Never put needle containers in the trash or recycling bin.
If you have a disposal contract, store the sharps and have them picked up in the right way.
Take the container to a Household Hazardous Waste Depot, place it in one of the Outdoor Needle Drop Boxes or take it to a local pharmacy that is a part of the Health Steward program.

Get Help with Substance Use in Rural Communities

If you or a loved one are struggling with fentanyl or opioid addiction, please get in touch with Luxe Recovery today. There are various treatment options which our knowledgeable admissions team can discuss with you.

Luxe Recovery offers a world class substance abuse and mental health treatment program to our clients as they make a commitment to overcome their addiction and live a fulfilling life of sobriety.