The entire nations have been hit hard by the opioid epidemic – and rural areas have been hit especially hard. Due to the limited availability of therapy and treatment resources, often, those who are using and far from care find it difficult to get out of the throws of addiction. Those is in the big cities aren’t spared, either though. Many large cities throughout the U.S. have become major hubs for illicit opioid distribution. Fentanyl and other lethal drugs are more and more frequently being mixed in with heroin, methamphetamines and cocaine, and users are often getting concoctions, mixing in drugs they didn’t bargain for.Experts are now forecasting that opioid overdoses will skyrocket in both rural and urban areas in the coming years because of this lethal mixing. Their findings were published online July 28 in JAMA Network Open.“The coming wave of opioid overdoses will be worse than ever seen before,” said researchers from Northwestern Medicine in Chicago.

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“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,” said corresponding author Lori Post, Director of the Buehler Center for Health Policy and Economics at Northwestern University Feinberg School of Medicine. “Not only is the death rate from an opioid 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.”For the study, the team analyzed data pulled from the U.S. Centers for Disease Control and Prevention (CDC)’s WONDER database for 3,147 counties, and areas equivalent to counties, in order to review geographic trends in opioid deaths between 1999 and 2020.The study found that deaths in 2020 were “escalating faster in rural areas than in cities. Between 2019 and 2020, rates of overdose deaths escalated for the first time in six types of rural and urban counties,” Post said. “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.”Examining toxicology reports from users who overdosed, the team found that individuals are using and carfentanil (a synthetic opioid approximately 100 times more potent than fentanyl) in combination with methamphetamines and cocaine.“The stronger the drugs, the harder it is to revive a person,” explained study co-author Alexander Lundberg, assistant professor of emergency medicine at Feinberg. “The polysubstance use complicates an already dire situation.”Post added, “It appears that those who have died from opioid overdoses had been playing pharmacist and trying to manage their own dosing. 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 study authors said solutions to dangerous mixing might include methadone centers, which are far more common in urban areas.“Rural areas have no medication-assisted treatment (MAT) options, Post said. She added, “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.”

Sources:

Wave of Opioid Overdoses Expected to Hit U.S. Rural, Urban AreasGeographic Trends in Opioid Overdoses in the US From 1999 to 2020