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Opioid abuse in rural America

Adjusting for population density, studies show opioid abuse is more prevalent in rural areas than in metropolitan or suburban areas. While strong evidence is lacking as to why, medical professionals have a number of theories.

Macro, local and micro risk levels

In a February 2014 article in the American Journal of Public Health, researchers examined the macro, local and micro contexts that frame the cause of drug use. Social context, family context, peer influence, endogenous (internal) factors and drug properties comprise these levels. Also known as ecosocial theory and ecological systems theory, each level relates to social context structure. For example, economic hardship, systemic discrimination and other significant life stressors fall under the macro level rubric. Family dynamics and peer influence are at the core of the local context level. Endogenous factors (the micro level) include genetics, neurobiological factors, gender, age and psychiatric morbidity.

Extrapolating the risks: looking for clues in the country

Working within these risk levels, researchers looked for reasons peculiar to rural living that contribute to opioid abuse. They found that more opioid analgesics are prescribed in rural areas as compared to suburban or urban areas. A September 2014 study in Rural and Remote Health supports this finding. A three-month survey of 64 patients (the majority of whom had annual incomes of less than $13,000) found the majority listed complaints of chronic pain and depression. These individuals primarily resided in medically underserved areas and received treatment at federally qualified health facilities.

Unlike suburban and urban communities, rural communities are close-knit and typically involve extended families living in relative proximity. This solidarity can be detrimental in a number of ways. First, researchers find individuals living in rural communities are more tightlipped when it comes to discussing personal issues. Second (and this falls under the local context rubric), individuals in rural communities are more likely to share opioids. Researchers cite this type of diversion as the main source for the relative abundance of these drugs in rural communities.


Remote Health notes over the past two decades, young people have left rural communities. According to the 2010 Census, the 65 and older population in West Virginia (a state with many rural communities) is twice that of people aged 18 to 24. In 1970, the difference in population between these two demographics was negligible. Communities with older citizens do not have a producing workforce, excluding retirement communities such as in Florida or Palm Springs.

This results in economic hardship (macro level) for the community. Stagnant economic conditions and a sedentary elder population create a fertile environment for drug use in these rural communities. Also, on average, individuals 65 to 69 take 14 prescriptions a year. Seniors make up 13 percent of the population but consume 40 percent of all the prescriptions dispensed in the U.S.

Economic conditions

The 2008 recession impacted the entire country, but rural communities are still mired in economic malaise. The Journal of Public Health and Remote Health cite unemployment as well as the specter of no sustainable employment as two reasons why drug use is so prevalent in rural communities. The American labor market requires high-skilled workers in health, computing and telecommunications. Urban communities have greater diversity in labor markets. Rural communities simply can’t compete.

Researchers did not cite endogenous reasons for rural opioid use.

Sovereign Health Group’s El Paso treatment facility offers treatment for individuals with co-occurring conditions. There is a strong correlation between mental illness and substance abuse. Call our helpline to find out more about our treatment programs.

About the author:

Darren Fraser is a content writer for Sovereign Health Group. He worked two and half years as reporter and researcher for The Yomiuri Shimbun until they realized he did not read, speak or write Japanese and fired him. Undeterred, he channels his love of research into unearthing stories that provide hope to those dealing with addiction and mental illness. Darren loves the Montreal Canadiens hockey club and horror films and would prefer to enjoy these from the comforts of his family’s farm in Quebec. For more information about this media, contact the author at

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