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12-16 The opioid epidemic in rural America

The opioid epidemic in rural America

Growing up in a small town can often be a great experience for children and adolescents. They have more room to play outside due to more space, a closer knit community due to smaller populations, a simpler lifestyle due to the lower cost of living, and often very strong morals and family values secondary to strict religious beliefs. Depending on how small the community, it is very common for most people to know each other within the town, making for a true sense of community. Family dinners, church on Sunday and blue-collar middle-class working people comprise most of the small towns in America.

Despite a simpler lifestyle compared to big city living, sociology studies have shown that prescription painkillers, known as narcotics or opioids, are more abused among adolescents living in small towns than those living in urban areas.

Signs that are easy to hide

Evidence has shown that adolescents in rural communities are 35 percent more likely to use prescription painkillers than adolescents in urban areas. The prescription painkiller industry has caused an epidemic, and studies have shown that over 1.3 million adolescents have abused prescription painkillers within the past month.

Prescription opioid abuse is easy to hide for adolescents compared to other substances such as alcohol and marijuana. Being under the influence of alcohol or weed significantly alters behavior and inhibition, and physical signs are apparent, making it difficult to hide this addiction from their parents. On the other hand, opioid use is much easier to hide, because physical signs are not as apparent and acute behavior is generally not altered. Drowsiness is the most common behavior alteration, but adolescents are known to oversleep due to their hormonal physiology at this stage of their lives.

The lack of primary care physicians

So why are adolescents in small towns more likely to be addicted to prescription opioids compared to adolescents in urban areas? According to studies, it has nothing to do with being bored in small towns but rather has more to do with easier access to these substances.

One of the leading reasons for the increase in opioid abuse is directly related to the health care systems in rural America. Rural areas have always had fewer primary care physicians, because urban areas are generally more attractive locations to live. Rural areas continue to try to recruit new physicians by offering them higher compensation and reimbursement on student loans, but this is often not enough.

As a result of this lack of primary care physicians, adolescents are more likely to go to an emergency room to seek generalized medical care, which is a major problem in itself as emergency departments should be for emergency use only. Unfortunately, patients cannot be turned away from emergency rooms, and emergency room physicians are more likely to prescribe opioids for short-term use more than primary care physicians, leading to an increased use in rural areas.  

“There has been a shortage of primary care practitioners in rural areas for a long time,” said Shannon Monnat, Ph.D., assistant professor of rural sociology, demography and sociology at Penn State and the study’s corresponding author. “Often, emergency rooms or urgent care clinics might be the only place for someone to receive treatment in a rural area.”

The lack of awareness and treatment

Another reason for the increase in opioid use in rural areas is the lack of awareness about addiction and the lack of substance abuse treatment facilities. Geographically, treatment centers are situated in bigger cities toward the coastal areas.

Two factors that have prevented an even greater increase in prescription painkiller abuse is religion and limited access to drugs compared to urban areas. Although emergency rooms are prescribing opioids in a liberal manner in rural areas, obtaining illicit street narcotics is more difficult than in urban areas. Additionally, religious standards in rural areas are more common and quite strict compared to urban areas, creating more peer pressure not to use and abuse drugs.

Regardless of whether a person lives in an urban or rural location, opioid abuse can ruin lives. Professional treatment has been shown to have the best outcomes.

Sovereign Health is a leading treatment provider with locations across the United States that treat people with addiction and mental disorders. Our multidisciplinary professionals use evidence-based therapies to treat people with opioid addictions. For more information, call the 24/7 helpline.

About the author

Kristen Fuller, M.D., is a senior staff writer at Sovereign Health and enjoys writing about evidence-based topics in the cutting-edge world of medicine. She is a physician and author who also teaches, practices medicine in the urgent care setting and contributes to medicine board education. She is also an outdoor and dog enthusiast. For more information and other inquiries about this article, contact the author at   

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