The Drug Crisis in Rural Communities:
Part 2: Factors Contributing to Rural Addiction
By Glenn Daman
What happened? From being characterized as the ideal place to raise a family, rural America has become what is now referred to as the new Ghetto, where drug addiction and overdose rivals the inner city. How did we get there? What happened to bring about this dramatic shift throughout rural communities? This question has plagued rural sociologists and national leaders in recent years as they try to understand why rural communities have seen such a dramatic rise in opioid addiction and deaths. While the rapid change certainly stems from individual choices, these decisions are never made in complete isolation from changes going on at a societal level. Too often we attribute drug addiction solely to the destructive choices a person makes. Certainly, it is true that we are accountable for our actions and decisions. However, we must also understand the many factors and issues found in a local community contributing to a person’s addiction. A person does not become addicted to opioids just because they decided one day to do so. There were a series of events and issues influencing the individual’s circumstances and decisions leading to his or her personal struggle. If we fail to understand these issues, we can not only become overly judgmental, but, we will fail to bring lasting change and hope to the person and community. To deal with the crisis of drug addiction we must not only help the individual, we must also understand the contributing factors within the community which influence the person’s use and subsequent misuse of opioids.
As pointed out in part 1, many of the occupations in rural communities rely heavily upon physical labor. As a result, injuries frequently occur, which, in turn, results in a loss of critical income. Consequently, instead of allowing time off to heal, people need to continue to perform their jobs in spite of the injury. A farmer, for example, cannot afford to stop harvest for two or three weeks to allow a back injury to heal. The urgency of the job requires that a person “push through the pain.” When opioids were first introduced, they provided a quick answer. They brought immediate relief from the pain, thus enabling the individual to continue working. But the blessing also brought a curse, for opioids were unknowingly highly addictive and while they brought relief, they also brought enslavement to addiction. This reversed the normal trend of the growth of illicit drugs. Typically, when an addictive drug was first used, it was introduced in the large urban areas and then spread to the rural communities. But in the case of opioid addiction, it began in isolated communities in the Appalachia, Midwest and rural Maine and then spread throughout the country.[i] This growth was not only fueled by the high-risk industries, but also by the lack of any available resources to help those struggling with addiction. Because these isolated small communities were politically unimportant, they did not receive critical government funding to provide treatment facilities. Consequently, the crisis was born.[ii]
Aging Rural Population.
When one thinks of drug addiction, one usually thinks of a young person from a dysfunctional home or circumstance who turns to drugs for an escape. Not only is this a mischaracterization of drug addiction as a whole, it is especially a misconception of the crisis in rural communities where there has been a rapid rise of opioid-related deaths. According to the Centers for Disease Control and Prevention (CDC), almost 44 percent of opioid-related deaths in rural areas in 2015 were among older adults and 3.7 percent involved adults 65 and older. [iii] Just as the case with injuries, this was driven largely by the search for chronic pain management which is more prevalent among the rural people.[iv] Because Physical Therapy was often not available or accessible to rural people, doctors prescribed opioid prescriptions as the best solution. This led to even greater abuse of the elderly. But this had further consequences beyond just opioid misuse and overdoses. The National Committee for the Prevention of Elder Abuse has linked substance abuse to other forms of mistreatment, including physical mistreatment, emotional abuse, and financial exploitation by family members who themselves are abusing opioids and self-neglect.[v] As rural America continues to age, this will only increase.
A further factor impacting the rise of opioids is the availability of the drugs. While medical treatment fueled the prescription of drugs, their increased presence in the home-made access easier for people to use them nonmedically. Studies have indicated that the majority of adults who used Opioids non medically obtained them from friends and relatives or from street-level dealers. In rural communities, families have a stronger kinship. While this is often a benefit for individuals, it has also been demonstrated that it significantly contributes to the misuse of prescription opioids in two important ways. First, rural people often lack access to healthcare due to economics as well as distance. As a result, this led to more self-medication as well as drug-sharing among family and friends as people try to help their family and neighbors deal with pain management. This results in an increase of addiction and overdose.[vi] Second, because of its widespread use, opioids are frequently available in many medicine cabinets in the homes, thus providing easy access for people to obtain the drug for nonmedical use. This is especially the case for adolescence who can easily access the drugs either in their own home or in the homes of family and friends.
Research has consistently demonstrated that drug abuse is more prevalent when individuals suffer socio-economic disadvantages. Studies have shown that rural communities share the same level of disadvantages as high-risk central cities. These disadvantages included individuals who have not completed high school, receive publication education, unmarried mothers, or experienced long-term unemployment.[vii] Just as these factors contribute to substance abuse in the inner-city so also, they contribute to drug abuse in rural communities, especially among the youth.[viii]
Along with the socio-economic disadvantages, a significant impact is the breakdown of the family unit with rural communities. In families where there limited parental monitoring and oversight as well as the failure to have clearly defined rules and structure within the family. While the perception of rural communities is that there remains a strong sense of family cohesion, the reality is different. With the outmigration of rural youth, those that are left behind often struggle with poverty and social dysfunctions. As a result, more and more of adolescents are becoming involved in illicit drugs.[ix]
Increase of Gang Presence.
Rural communities have long been regarded as insulated from the problems of the inner city, but in recent years, illicit drug manufacturers and deals have begun to view rural communities as both an opportunity for new markets, but also for a place to manufacture drugs. Manufacturers of illicit drugs look for isolation as the best way to avoid detection by law inform cement. Consequently, they have increasingly seen rural areas as a viable option. As a result, most laboratories are now confiscated in rural areas.[x] Corresponding to this increase has been the increase of the presence of gangs in rural communities which has further increased the presence and availability of drugs in rural communities.[xi] But not only has gangs found rural communities a viable option for production, but also for recruitment as well. Because of the economic downturn in rural communities, young people cannot find legitimate jobs and so they turn to selling drugs as an alternative. While gangs are not as prevalent in rural communities they are still present with 25.4 Percent of smaller cities (2,500-49,999) and 16 percent of rural counties report the presence of gangs in 2012.[xii]
All this points to the reality that the opioid crisis in rural communities is not diminishing and will continue to plague rural areas. To address these issues it will take the whole community, including the church, to work together to address both the reality of drug addiction as well as the causes and contributing factors. Only when we do so with the trends be reversed.
[i] Beth Macy, Dopesick, (New York: Little, Brown and Company, 2018), p. 8.
[ii] Ibid, p. 8
[iii] William F. Benson and Nancy Aldrich, “Rural Older Adults Hit Hard by Opioid Epidemic, Aging Today, American Society on Aging”, https://www.asaging.org/blog/rural-older-adults-hit-hard-opioid-epidemic
[iv] Katherine M. Keyes, Magdalena Cerda, Joanne E. Brady, Jennifer R. Havens, Sandro Galea, “Understanding the Rural-Urban Differences in Nonmedical Prescription Opioid Use and Abuse in United States,” February 2014, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935688/
[v] Benson and Aldrich, “Rural Older Adults hit hard by Opioid epidemic.”
[vi]Paul Moore and William Benson, “Opioid Issues and Trends Among Older Adults in Rural America,” https://dsamh.utah.gov/pdf/OA%20Conference/Key%20Facts%20OPIOID%20ISSUES%20AND%20TRENDS%20AMONG%20OLDER%20Adults%20in%20Rural%20America.pdf
[vii] Elizabeth B. Robertson, Zili Sloboda, Gayle M. Boyd, Lula Beatty, Nicolas J. Kozel, eds. Rural Substance abuse: State of Knowledge and Issues. (Rockville, MD: National Institute on Drug Abuse, 1997,) p. 42
[viii] Jean Otto Ford, Rural Crime and Poverty, (Philadelphia: Mason Crest Publishers), p. 20
[ix] Ibid, p.368
[x] Patrick J. O’Dea, Barbara Murphy, Cecilia Balzer, “Traffic and Illegal Production of drugs in Rural America” 1997, https://pdfs.semanticscholar.org/63d9/fe2320a54a701ae42c8f6008026a4f1417bd.pdf?_ga=2.218515417.1908936803.1597087178-1233170360.1597087178
[xi] James C. Howell and Arlene Egley, Jr. “Gangs in Small Towns and Rural Counties.” National Youth Gang Center, No. 1, June 2005, https://www.nationalgangcenter.gov/Content/Documents/Gangs-in-Small-Towns-and-Rural-Counties.pdf
[xii] Prevalence of Gang Problems in Study Population, National Gang Center, 2012 https://www.nationalgangcenter.gov/Survey-Analysis/Prevalence-of-Gang-Problems#prevalenceyouthgangstudy