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The Church and the Drug Crisis in Rural Communities Pt 1 the rise of opioids

The Church and the Drug Crisis in Rural Communities

Part 1:  The Growing Crisis of Drug Addiction in Rural communities.

By Glenn C. Daman, D.Min.

            For many, the rolling fields and lush farmland provides a pastoral picture of tranquility and comfort, brining nostalgic memories of a simpler life where families worked together, ate meals around the evening table together and children spent their afternoons in a carefree world of exploration and wonderment.  But perception, often colored by misconceptions, is often vastly different than reality.  Look beyond the golden waves of grain and one finds rural communities struggling to exist and facing challenges comparable to the ghettos of the large urban inner cities.  Along with struggles with chronic poverty, increasing crime and growing anger and resent that their issues are being overlooked, rural communities are facing a sharp increase in opioid and drug addiction and deaths.

The Rise of Drug Addiction in Rural Communities

            Recently there has been a great deal of attention given to rise of opioids and opioid related deaths in rural communities.  However, for students of trends in rural communities, the sudden rise in opioid misuse is not surprising.  In 1992 sociologist began to warn that the image of a rural America remained untouched by the larger problems of society was a myth.  No longer was rural America the idyllic Mayberry which the sheriff’s office greatest concerning was the ongoing escape of a fugitive cow.  Studies sponsored by the Tri-Ethnic Center for Prevention Research at Colorado State University and subsequently published under the title of Drug Use in Rural American Communities bought to light troubling trends regarding the drug use of rural youth. While eighth graders were less likely to use drugs in rural communities as compared to urban adolescents, by the time students were seniors in High School, there was no longer any significance difference.[i]  Especially troubling was the increase drug use among minorities, particularly among Native Americans.  Nearly a third of Native American eighth graders indicated that they would likely use drugs sometime in the future.[ii]

            It is not surprising that in 2008 Jean Otto Ford would warn that gangs were becoming prevalent in many rural communities.  In 2008, the Navajo Nation would identify seventy-five active gangs on the reservation.[iii] Along with the increase of gangs in rural areas came a new onslaught of drug abuse by rural teens.  While drug-related arrests decreased between 1995 to 2002 in urban communities by 23 percent, in the same period rural communities would show an increase of 21 percent.[iv] Even as government agencies and social activists were seeking to stem the tide of economic and social decline in the inner cities, the rural communities were disintegrating with little attention given to them.  Harland Padfield would write, “it is a fundamental illusion of American culture: the persistent celebration of rural life in the midst of its destruction.”[v]  All the features once characterizing the urban ghettos was now becoming a reality in rural communities.  Drug abuse began to plague communities as the highest rate of drug use among teens was now found in rural communities.[vi]

            However, the decline was seen in more than just the increase of drug abuse among the teens.  It was also seen in the economic collapse experienced by many rural communities, bringing chronic poverty as unemployment skyrocketed. Many of the rural young people fled rural communities is search of better jobs in urban areas resulting in a rural brain drain that continues to this day.  This brought a sense of hopelessness, despair and anger.  Osha Grey would point out, “The hard ugly truth is not only that we have failed to solve the problems of our urban ghettos, but that we have replicated them in miniature a thousand times across the American countryside.”[vii]

            Tragically, what began as a disconcerting problem has now blossomed into a full-fledged crisis in rural areas.  While the crisis of crack and cocaine misuse began to unfold in the urban areas, an opioid epidemic has been sweeping across the rural landscape. In the last twenty years a tsunami of opioid deaths that have plagued rural communities (see maps).[viii]  The statistics are staggering.  Between 1999 and 2016, the opioid death rate increased by 158 percent in large central metro counties, 507 percent in large fringe metro counties, 429 percent in medium/small metro counties and 740 percent in nonmetro counties. The greatest increases occurred in the rural Midwest (1,600 percent) and rural Northeast (1,141 percent).[ix]

Not only did rural communities see a dramatic increase of drug use and drug related deaths, the path it took was significantly different than its urban counterpart.  While urban communities saw an increase in the use of crack, cocaine and other illegally manufactured narcotics, in rural communities the increase of drug addiction and death was fueled by prescription drugs.  When methadone, hydrocodone and oxycodone first arrived on the scene it was touted as the answer for dealing with chronic and debilitating pain.  Providing immediate relief to many who were suffering from work related injuries, it provided an answer for those whose careers and livelihood depended on the ability to perform physical labor. Between 1997 and 2007, the use of these prescribed pain relief increased 13-fold, 4-fold, and 9-fold respectively.  By 2010, enough prescription opioids were sold to medicate every adult in the United States with a dose of 5 milligrams of hydrocodone every 4 hour for 1 month.[x] Since most jobs in rural communities require physical labor, these drugs seemed to provide a quick solution to injuries that would otherwise prohibit a person from accomplishing their work and earning their livelihood.  But what brought immediate and temporary relief for pain, thus enabling a person to keep on working, also brought long-term negative consequences. As people increasingly turned to prescriptions to provide relief to pain, they became addicted. In this, rural addiction differed from the urban counterpart.  While people in urban areas become addicted to synthetic opioids (such as fentanyl) and heroin, rural people became addicted to prescription opioids.  Thus, in rural communities the drug crisis was driven by overmedication and abuse of prescriptions of legal opioids.[xi] Consequently, rural areas experienced a greater number of drug overdose deaths related to prescription opioids (see chart).[xii] In 2019, prescription opioids were involved in 31 percent of drug overdose deaths in non-metro counties, compared to 24 percent for synthetic opioids, and 16 percent for heroin compared to metropolitan counties where synthetic opioids and heroin contributed to 58% of all drug overdose deaths.[xiii] This then filtered down to the use among rural teens.  Because of the availability of prescription opioids and the fact that it is easily accessible in many medicine cabinets in rural homes, rural teens are 26% more likely than urban teens to use prescription drugs non medically, with 1 in 8 of rural teens reporting that they have used prescription opioids nonmedically.[xiv]

The Rise of Trafficking, Illegal Drug Production and Gangs

            Addiction and drug abuse are never a problem in isolation from other social and economic problems in a community.  With the increase of drug addiction comes the increase of drug trafficking, illegal production, and the growth of gangs is many rural communities.  As drug addiction increased, drug dealers found a new market in small towns and countryside.   As they did so, they discovered two advantages.  First, because of the isolation of rural communities they discovered that there was less chance for their production centers to be discovered.  Second, many law enforcement agencies in rural communities were not as equipped to deal with drug trafficking, thus enabled them to increase production without any detection.  The chemical odors and toxic waste associated with the production of Methamphetamines relies upon isolation as the best protection against detection.  Consequently, they often establish their laboratories in rural areas to minimize the risk of discovery.  It is not surprising then that the majority of laboratories are confiscated in rural communities where their operations are typically larger and more sophisticated than what is found in urban communities.[xv]

            Along with Methamphetamines, suppliers and manufacturers of Crack have expanded their markets to rural communities.  With this expansion has come the presence of street gangs such as the Crips and the Bloods who are finding new opportunities for growth in rural areas.[xvi]

            As drug production increased, gangs began to move out of large urban areas and becoming present in smaller towns and rural communities. Rural communities offer an appealing opportunity for gang expansion.  Their criminal activities are less noticeable from law enforcement and they do not face the challenge of competing with different gangs in the community.  The FBI, in their assessment of gang activity warned, “Gang members are migrating from urban areas to suburban and rural communities to recruit new members, expand their drug distribution territories, form new alliances, and collaborate with rival gangs and criminal organizations for profit and influence.”[xvii]

            All this points to a growing challenge facing rural communities, one that communities and the church cannot ignore.  But this will require the church to develop a new focus of ministry.  Often, behind the walls of the church we become insulated from the struggles people are facing around us.  We still view rural communities through the rose-colored lenses of past nostalgia.  However, as the opioid crisis of drugs, we need to look at our communities more closely, when we do, we find ourselves being called to serve in communities in a far deeper crisis than we imagined.

Pt. 2: Contributing Factors in the Rise of Drug Abuse in Rural Communities.

Pt. 3: The Challenges for Drug Abuse Treatment in Rural Communities.

Pt. 4: The Role of the Church in Responding to The Drug Crisis.


[i] Ruth W. Edwards, ed. Drug Use in Rural American Communities, New York: Harrington Park Press,1992 p. 13.

[ii] Ibid. p. 89.

[iii] Jean Otto Ford, Rural Crime and Poverty, Philadelphia: Mason Crest Publishers, 2008 p. 28

[iv] Ibid, p. 28

[v] Osha Gray Davidson, Broken Heartland: The Rise of America’s Rural Ghetto, Iowa City: University of Iowa Press, 1996, p. 1

[vi] Rural Crime and Poverty, p. 28

[vii] Broken Heartland, p. 158

[viii] Richard Florida, The Changing Geography of the Opioid Crisis, https://www.bloomberg.com/news/articles/2019-12-05/how-opioid-deaths-differ-in-rural-and-urban-areas, 9/5/2019, accessed 7/27/2020.

[ix] Shannon M. Monnat and Khary K. Riggs, The Opioid Crisis in Rural and Small Town America.  University of New Hampshire, Carsey School of Public Policy, National Issue Brief #135, Summer, 2018,

[x] Understanding the Rural-Urban Differences in Nonmedical Prescription Opioid Use and Abuse in the United States, Katherine M. Keyes, Magdalena Gerda, Joanne E. Brady, Jenifer R. Havens and Sando Galea.  American Journal Public Health, February, 2014, 104(2): e52-59. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935688/, accessed 7/28/2020

[xi] Relationship between therapeutic use and abuse of opioid analgesics in rural, suburban and urban locations in the United states. Theodore J. Cicero, Hilary Surratt, James A. Inciardi, Alvaro Munoz. pharmacoepidemiology and drug safety 2007; 16: 827–840 Published online in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/pds.1452.  Accessed 7/28/2020

[xii] Richard Florida, The Changing Geography of the Opioid Crisis, https://www.bloomberg.com/news/articles/2019-12-05/how-opioid-deaths-differ-in-rural-and-urban-areas, 9/5/2019, accessed 7/27/2020.

[xiii] Shannon M. Monnat and Khary K. Riggs, The Opioid Crisis in Rural and Small Town America.  University of New Hampshire, Carsey School of Public Policy, National Issue Brief #135, Summer, 2018,

[xiv] Non Medical Prescription drug Use in a Nationally Representative Sample of Adolescents. Jennifer R. Havens, April M. Young, Christopher E. Havens https://jamanetwork.com/journals/jamapediatrics/fullarticle/384378, Accessed 7/28/2020

[xv]Patrick J. O’Dea, Barbara Murphy, and Cicilia Balzer, Traffic and Illegal Production of Drugs in Rural America, https://pdfs.semanticscholar.org/63d9/fe2320a54a701ae42c8f6008026a4f1417bd.pdf?_ga=2.108160386.1805620270.1595962479-403377059.1595962479, Accessed 7/28/2020

[xvi] Ibid

[xvii] Gang crime increasing in small cities, too.  https://www.policeone.com/gangs/articles/gang-crime-increasing-in-small-cities-too-AxVt9xGbcWdSgpFQ/ Accessed 7/28/2020