Over the past 21 years, opioid overdose deaths—from prescription drugs to heroin to synthetic and semisynthetic opioids such as fentanyl—have demonstrated a geographic pattern in their occurrence, as highlighted by a recent Northwestern Medicine study. However, the coming wave of overdoses will not discriminate between rural and urban areas. The study indicates that every type of county — from the most rural to the most urban — is predicted to see a dramatic rise in deaths from opioid-involved overdoses.
Escalation of Opioid Overdoses Across Regions
The opioid crisis has reached historic levels, fueled by a dangerous combination of synthetic opioids and stimulants such as cocaine and methamphetamines. This lethal cocktail makes it incredibly challenging to reverse overdoses. Lori Post, director of the Buehler Center for Health Policy and Economics at Northwestern University Feinberg School of Medicine, said:
“I’m sounding the alarm because, for the first time, there is a convergence and escalation of acceleration rates for every type of rural and urban county. Not only is the death rate from opioids at an all-time high, but the acceleration of that death rate signals explosive exponential growth that is even larger than an already historic high.”
The study, spanning the years between 1999 and 2020, examined trends in opioid-involved overdose deaths to understand the role geography has played throughout the three waves of the opioid crisis, and what is theorized to be a fourth wave. Data from the Centers for Disease Control and Prevention (CDC)‘s WONDER database was used, covering 3,147 counties and equivalents across a six-point urban-to-rural scale.
Rising Rates of Overdose in Rural and Urban Areas
Near the end of the available data in 2020, the researchers observed that overdose deaths in rural areas were escalating faster than in urban areas. For the first time, acceleration rates for opioid overdose deaths converged across all geographic types. Lori Post added:
“We have the highest escalation rate for the first time in America, and this fourth wave will be worse than it’s ever been before. It’s going to mean mass death.”
The potent mixture of fentanyl (a synthetic opioid 50 to 100 times more potent than morphine) and carfentanil (approximately 100 times more potent than fentanyl), combined with methamphetamines and cocaine, is creating a dangerous cocktail that makes it challenging to revive overdose victims, even with drugs like naloxone. Alexander Lundberg, assistant professor of emergency medicine at Feinberg, explained:
“The stronger the drugs, the harder it is to revive a person. The polysubstance use complicates an already dire situation.”
The Reality of Polysubstance Use
The study’s findings indicate that many individuals who succumb to opioid overdoses have been attempting to manage their own dosing, often mixing cocaine, methamphetamines, and opioids in dangerous quantities.
“It appears that those who have died from opioid overdoses had been playing pharmacist and trying to manage their own dosing,” said Lori Post. “This is a bigger problem because you have people misusing cocaine and methamphetamines along with an opioid, so you have to treat two things at once, and the fentanyl is horribly volatile.”
The Urban-Rural Divide in Treatment Access
Opioid addiction does not discriminate, affecting individuals from all walks of life. As Lori Post said:
“Nobody wants to be a drug addict. It doesn’t matter if you’re taking Percocet because you broke your back while mining or if you’re a high schooler who died because they got into grandma’s medicine cabinet. We need to look at opioid addiction and overdose prevention immediately.”
A major disparity lies in the availability of medication-assisted treatments (MAT), such as methadone or buprenorphine, which are crucial for treating heroin and synthetic opioid overdoses. Such treatment centers are typically located in urban areas, leaving rural communities without access to these life-saving resources.
“The only path forward is to increase awareness to prevent opioid use disorders and to provide medication-assisted treatment that is culturally appropriate and non-stigmatizing in rural communities,” Post emphasized.
Moving Forward: Addressing the Crisis
The coming wave of opioid overdoses is expected to be worse than ever, driven by the convergence of accelerating overdose rates across both urban and rural areas. Addressing the opioid crisis will require a multifaceted approach, including increasing awareness, reducing stigma, and expanding access to medication-assisted treatment, particularly in underserved rural areas.
Share your thoughts: How can we better bridge the gap between urban and rural areas in providing effective treatment for opioid addiction? Join the conversation in the comments below.
