America’s current opioid crisis is the symptom of a larger, deeper problem.

Over the 100 counties with the highest fatal drug overdose rates in the U.S., more than 75% are within the heart of Appalachia or the former U.S. industrial belt.

The connection between poverty, unemployment and addiction has been established, but…

new CDC research gives us a deeper look at the destructive stew in certain areas of the U.S., where Americans suffer both the devastating blows of economic disruption and the highest levels over fatal overdoses. Those in the treatment community have always understood that “addiction doesn’t discriminate,” however, it’s clear that the conditions that place people at greatest risk of addiction and overdose are more prevalent in some places than others. CDC data shows that, in addition to access to opioids, there are three main socioeconomic factors that explain why fatal drug overdose rates are higher in some areas than others: work, family and community. While pharmaceutical companies like Purdue Pharma and the others who manufactured and aggressively marketed Oxycontin and other opioids have provided the spark for today’s crisis, the fertile ground of despair in many American regions has fueled explosion. The addiction of hopelessness.

CDC data shows addiction (and deaths) are not geographically random.

Counties experiencing higher rates of poverty, joblessness, disability, single parent families, divorce and separation have much higher rates of drug mortality, even among places with similar access to opioids. The rust belt, while not alone in the addiction crisis, is certainly ground zero, and many of those afflicted will never get the help they need.

OxyContin and other strong opioids were heavily marketed in the mining-dependent Appalachian communities

More bad news for the hardest-hit communities.

Ultimately, the highest drug mortality rates are disproportionately concentrated in the economically-distressed mining, manufacturing and service sector dependent counties with high exposure to prescription opioids and fentanyl.

These communities have another problem. As the economic conditions worsen, community-level social infrastructure is crumbling or being eliminated altogether. Communities have been forced to disinvest in social resources over recent decades. Protective institutions, such as churches and other religious venues, are disappearing. Along with the disappearance of these structures, much of the meaning in the lives of the citizens has been swept away. What’s left is isolation. Research conducted in southwestern Pennsylvania involving adult addicts in the state concluded that the lack of connection to jobs, family and community is a common sentiment among many in the study. A 26-year-old resident says: “When I was little, it used to be pretty, everything was upbeat, there were people, and now there’s nothing. It went downhill really bad.”

By the 1990’s, once thriving manufacturing communities in Ohio, Pennsylvania, and other states anchored by steel, brickyard, energy and other manufacturing factories were long gone — replaced by big-box stores, check-cashing and rent-to-own services, strip clubs, pawn shops, scrap yards, and pain clinics where physicians handed out prescriptions for Oxycontin, and other narcotics like candy. As communities began to die, hopelessness took hold.
Many argue that the country’s overdose crisis has been driven almost entirely by the surge in prescription opioids. It is an undeniable fact that the widespread availability of powerful and incredibly addictive prescription opioids that started the current overdose epidemic, has since transitioned into heroin and fentanyl epidemics. But the CDC data indicates that opioids are a symptom of much larger social and economic problems facing the hardest hit communities, and pharmaceutical companies targeted these economically vulnerable places in the U.S., those with high rates of poverty, joblessness, pain and disability.

Solutions to combat the opioid crisis will only be effective if we address the social and economic factors at the core of the crisis.