Rural America—New Epicenter of Drug Use

The drug problem is no longer a “big city” problem—it's in every city across the US.

How did this happen?

Growing up in rural, farmland Michigan, I would never have thought that drug addiction would become a problem for those of us accustomed to country living. As a kid, drug addiction was almost unheard of in the small-town, Midwest regions that I called home. To my friends and me, drug use was always a “city kid problem.”

A lot of that has changed in recent years. Now, some drug trends are just as common and sometimes even more common in rural communities as they are in urban areas. How on earth did that happen?

A Closer Look at CDC Data and Why Drug Problems Have Spread to Rural America

“Though often perceived to be a problem of the inner city, substance abuse has long been prevalent in rural areas. Rural adults have higher rates of alcohol abuse, tobacco use, and methamphetamine use, while prescription drug abuse and heroin use has grown in towns of every size.” That is a direct quote from the Rural Health Information Hub. It's a citation from a report on the spread of drug and alcohol use in rural America.

Several factors have contributed to increased drug use statistics in rural America. In a lot of ways, this was a perfect storm, a cruel turn of events just waiting to happen.

It started with the already existing conditions of difficulty and impoverishment that often accompany rural living. These trends began long ago and are the result of decades of socioeconomic shifts within the country (that’s a talk for a different day). However, these shifts resulted in rural communities being afflicted with lower educational attainment, poverty, isolation, unemployment, reduced access to proper healthcare, and high-risk behaviors.

Around the turn of the century, major pharmaceutical companies began to send hundreds of millions of doses of high-strength, addictive, and potentially dangerous opioid pharmaceuticals into rural areas. Even if communities did not need the drugs, they got them anyway.

A recent article in the Washington Post talked about how pharma companies sent tens of billions of pills across America, much of which ended up in rural communities. Add that to already severe living conditions and growing access to illicit drugs, and it indeed was the perfect storm for a rural drug-addiction epidemic.

“Rural areas were hit particularly hard: Norton, Va., with 306 pills per person; Martinsville, Va., with 242; Mingo County, W.Va., with 203; and Perry County, Ky., with 175. In that time, the companies distributed enough pills to supply every adult and child in the country with 36 each year.”

Quoting the Washington Post: “Rural areas were hit particularly hard: Norton, Va., with 306 pills per person; Martinsville, Va., with 242; Mingo County, W.Va., with 203; and Perry County, Ky., with 175. In that time, the companies distributed enough pills to supply every adult and child in the country with 36 each year.”

The rural epidemic started with prescription pills. Then it ballooned into heroin abuse when heroin cartels saw a burgeoning demand for drugs in the U.S. thanks to the spread of opioid pharmaceuticals. Now rural communities are chock-full of pills, heroin, and synthetic opioids (hybrid opioid drugs made in illegal drug labs).

Will there ever be an end to this cataclysmic drug problem?

A Relevant Issue Brought to Light in the News, TV, and Celebrity Discourse

Anthony Bourdain
Anthony Bourdain,
(Image Source: Wikimedia Commons)

The late Anthony Bourdain, celebrity chef, author, TV show director, and Emmy Award winner, started raising awareness of the rural drug issue shortly before his death. Bourdain dedicated one of his episodes of “No Reservations” to exploring the malignant expansion of opioid drug use into rural America. That TV series is currently available on Hulu, Amazon Prime, iTunes, and Vudu.

In the words of Bourdain himself: “[The] ‘War on drugs’ implies an us versus them. And all over this part of America [rural America], people are learning there is no them. There is only us. And we’re gonna have to figure this out together.”

Another media channel, U.S. News, published a recent article titled, “Urban or Rural, the U.S. Drug Crisis Is an Equal-Opportunity Killer.” This was authored by Katelyn Newman, a staff writer for U.S. News.

The U.S. News article explores and quotes federal data—mostly information gathered from the Centers for Disease Control and Prevention. According to the research, “From 1999 through 2003, drug overdose death rates were higher in urban counties than in rural counties. Rates were similar from 2004 through 2006, then higher in rural counties from 2007 through 2015.”

The research goes on to discuss how drug-overdose death rates for urban counties were 6.4 per 100,000 population in 1999 but then soared to 22 per 100,000 in 2017. For rural areas, the rate was four deaths per 100,000 population in 1999, 20 deaths per 100,000 population in 2017. Urban deaths increased by almost four-fold; rural deaths increased five-fold.

For decades we have known that drug problems exist in big cities. But it is only just recently that the American people are being made aware of a very adverse change, i.e., the fact that rural areas are now just as likely to face drug abuse problems as cities. That has been a rather rude awakening.

Finally, the American people are starting to wake up to the toxic and lethal nature of our expanding drug problem. Celebrities and major news media are reporting it. Awareness is coming up. This writer hopes that we are mere months away from a shift towards reducing the drug problem as opposed to just coping with it.

How Can We Reverse the Drug Epidemic?

There is, dare I say it, a glimmer of hope on the horizon. From 2017 to 2018, it looks as though drug overdose deaths have declined slightly—perhaps by five percent. That was reported in the periodical for the American Hospital Association, and it too cited CDC research.

According to Health and Human Services Secretary Alex Azar, “While the declining trend of overdose deaths is an encouraging sign, by no means have we declared victory against the epidemic or addiction in general. This crisis developed over two decades, and it will not be solved overnight. We also face other emerging threats, like concerning trends in cocaine and methamphetamine overdoses.”

Now is by no means the time to rest on our laurels. Even if the preliminary predictions are 100 percent accurate, a five percent reduction in drug overdose deaths from the 70,200 deaths in 2017 would still leave us with about 66,000 people who died from drug overdoses in 2018. We have to keep working to solve drug addiction in America. It starts with getting those who are currently addicted to drugs to get off of drugs with the help of residential treatment centers.

If you know someone who is struggling with a drug problem or an alcohol addiction, do your best to get them help through a residential drug and alcohol addiction treatment center. Millions of people struggle with drug habits in America. Our drug crisis, its death toll, its destruction of American families, and all of the ancillary problems that go along with it are not going to diminish until we help those who are addicted to break free from the chains of drug use.


Reviewed by Claire Pinelli, ICAADC, CCS, LADC, MCAP, RAS



After working in addiction treatment for several years, Ren now travels the country, studying drug trends and writing about addiction in our society. Ren is focused on using his skill as an author and counselor to promote recovery and effective solutions to the drug crisis. Connect with Ren on LinkedIn.