Courtesy of frankieleon/
United States / Opioid Epidemic

Small Towns, Big Problems

Over the course of a decade, the opioid epidemic has crept into our homes, schools, and neighborhoods, disrupting communities, destroying lives, and leaving users stuck in a never-ending cycle. It has contributed to the deaths of twenty-seven thousand people each year, surpassing cocaine as the leading cause of drug related deaths in the United States. 2014 marked the highest number of overdose deaths in our nation’s history, sixty percent of which involved opioids. This article, an examination of the roots of the opioid epidemic and its influence on small towns, will be the first of a series exploring the complexities of opioid addiction in America.

The path to prescription drug addiction often begins with a sports injury or routine oral surgery, when prescribed opioids are used for pain relief. During the recovery, patients may build up a tolerance towards the prescription drugs and subsequently find themselves going through withdrawal once off the medication. Craving the high the pills offer, these future addicts begin to seek out similar medications to counter withdrawal symptoms, knowing that a dose will take away any sickness or pain they are experiencing.

Users sometimes continue taking pills left over from their prescriptions, a practice especially associated with oral surgery patients, who are prescribed sixty hydrocodone or oxycodone, or about fourteen days of medication. Typically, the patients will use only twenty pills and then switch to over-the-counter pain medications. Some patients will continue taking the opioids every day, and when the prescriptions run out, they might try to steal medication. Fifty-three percent of the time, users will acquire the medication for free from friends and family. Unfortunately, when grandma’s medicine cabinet eventually runs out and “doctor shopping” fails, they turn to buying pills and harder drugs from dealers.

Users are unable to foresee that these prescription pills are often the gateway to heroin. Most opioid addicts are certain they will never use heroin, but prescription pills often become too expensive to be sustainable and not strong enough to counter the built-up tolerance of the users. So users choose a $40 bag of heroin over an $80 pill.

Less frequently, adolescents get hooked on opioids through experimentation. When alcohol and marijuana become boring, teens will consider opening the bottles of leftover pills they find in their medicine cabinets. To them, it seems like a win-win: they get a better high than marijuana and perceive the health risks to be much less than those of harder drugs like cocaine or molly. Users who see prescription drugs to be low risk are more likely to use them than those who see them as high risk, which leads many users to try prescription pills and become addicted, unaware that these drugs can be just as harmful. Low risk perception is disproportionately high in high school and college students, causing the population of prescription opioid users who use for fun to be skewed towards younger age groups.

From teenage experimentation, the journey of drug addiction continues, leading to thousands of deaths in every demographic. The opioid epidemic affects cities, rural towns, and everywhere in between, but small towns are hit especially hard. In some of these towns, particularly in the eastern United States, up to one fourth of the population are current opioid users. In Huntington, West Virginia, a town of forty-nine thousand, twelve thousand people currently use opiates and one third of them live in poverty. On August 15, 2016, emergency responders in Huntington revived twenty-six overdosed people in a five-hour period.

Over the past thirty years, Huntington has been struck by tragedy and skyrocketing unemployment, leaving many citizens impoverished and feeling hopeless. Recently, the town’s economy suffered as coal mines began to close, laying off hundreds at a time. These layoffs led to an increase in drug use, especially as residents looked for emotional relief in prescription pills like antidepressants. Unemployment led to poverty and the need for cheaper drugs such as heroin. Huntington has been transformedonce a thriving town, home to Marshall University, it is now America’s drug death capital.

Huntington is an extreme but clear example of what any town could become. With the wrong mixture of tragedy, unemployment, and access to drugs, any town is at risk.

Small towns are more vulnerable than cities. Rural places have a greater risk for drug use because of smaller economies that are dominated by a single company that provides most jobs, closer communities that are powerfully affected by death and tragedy, intertwining family and friend relationships that connect all residents to dealers, and smaller police and emergency response forces that do not have the resources to educate and help residents, among other reasons. Issues that may seem insignificant in large cities, like car crashes or layoffs, are devastating in small towns. As medical issues and needs align across the town, the demand for painkillers grows, and dealers may jump on the opportunity to offer cheaper options.

Furthermore, cities can support large hospitals that are equipped with research facilities that study substance abuse, which means there are many programs available for addicts to be treated and many contemporary treatment options being tested. Small towns do not have these resources at their disposal. Patients must travel out of town, sometimes even out of state, to get the treatment they need. In one case, a recovering addict in Vermont had to travel two hours from Burlington to White River Junction every day to get his prescription. Furthermore, communities lack the doctors and facilities that supply medications required for relapse prevention. These patients spend half of their day traveling to get a prescription and, in turn, lack the time to work a full time job. This difficulty leads to poverty, and often to relapse, because the system makes recovery more difficult than it needs to be.

The problem is easy to identify, but practical solutions are difficult to think up. An effective way to support addicts would be to create more proactive legislation. Often, the state government pays for the transportation of patients who must travel out of town, putting money toward “revolving door” solutions that solve immediate problems rather than finding long-term solutions. State governments should choose to face a deficit now in order to create a solution for later. If states spend more on drug recovery centers now while still paying for transportation, they will save money on fewer transports later. With more programs in place around the state, more users will have opportunities to enter recovery programs. The population of users should decrease, allowing the state to save money that would normally go toward transportation, naloxone, and clean needle exchange. Further, when the need for long distance travel diminishes, recovering addicts will have more time to work, therefore lowering poverty rates and helping the economy. A stronger state economy would return the favor by giving the state larger funds to spend on recovery medications and programs.

As the country continues to fight the opioid epidemic, our leaders and communities must consider the catastrophic effects in small towns. By viewing small towns as microcosms for the national problem, we can test proactive methods that will save lives, decrease poverty, and feed the economy.