Is Georgia’s Drug Problem Worse in Rural Counties?

In an alarming find, the most consistent increase of drug abuse in the United States — including deadly overdoses — has been found in rural communities. While most drug and alcohol prevention and recovery efforts have focused more on the densely populated cities over the years, studies show that rural areas have a pressing demand for these services. Sadly, underfunded research, untrained professionals, and ill-equipped facilities in rural counties have proved inadequate to combat this unfortunate trend. Georgia rural counties are no exception, and regrettably face the overwhelming task of confronting the many problems of rising drug, tobacco, and alcohol addiction.

Grim Statistics

Overdoses are now the leading cause of injury death in the country, overtaking car accidents. In 2015 alone, 52,000 people died from a drug overdose.

In 1999, deaths from drug overdoses were higher in urban areas, 6.4 per 100,000 compared to 4.0 per 100,000 in rural areas. But by 2004, those rates were identical, and by 2015, the rate of overdose deaths in rural areas had surpassed those in the cities, 17.0 per 100,000 in rural counties to 16.2 per 100,000 in cities.

Georgia is among the 11 highest states with the most prescription opioid overdose deaths. Georgia hospitals have admitted overdose victims at an estimated 1000% more than they have in a decade. Prescription opioids, pain medicine prescribed by a trusted doctor, are the number one factor that has lead to the heroin epidemic in Georgia. Pharmaceutical companies have been sued and forced to pay billions in lawsuits, falsely claiming drugs like OxyContin were safe, marketing the highly addictive drug in a race for profit.

In 2015, 1,307 people overdosed in the state of Georgia. Of these overdoses, 68% were caused by prescription opioids, and to a lesser extent, heroin.

Opioids

According to the Substance Abuse Research Alliance (SARA), a Georgia Prevention Project, “Opioids are a class of drugs that act on the body’s opioid receptors including natural, semi-synthetic and synthetic opioids. Natural opioids include drugs such as morphine, which are derived from the resin of the opium poppy, semi-synthetic opioids such as hydrocodone and oxycodone, and synthetic opioids such as fentanyl and methadone.”

Because opioids imitate the body’s response to pain and provide significant relief, they are often prescribed to people in recovery from surgery, those in extreme accidents, or people managing their cancer treatment. The drug lends the body a temporary liberation from the pain and also releases dopamine, which creates a pleasing, euphoric effect. Because of this effect, and because it fails to address the root cause of the pain, patients often become hooked on the medication. Opioid treatment can lead to hyperalgesia, a condition that reduces the effects of the medication and increases sensitivity to pain. Because of these amplified sensations, patients become dependent on opioids for pain management and will continue to seek more potent doses.

OxyContin

Doctors have known for a long time the dangerous effects of opioids, and used them sparingly, to allow a dying patient to suffer peacefully, or as an alternative to less effective treatments for extreme pain. And then in 1995, Purdue Pharma, a private company owned by the Sackler family in Connecticut, released OxyContin, a long-lasting narcotic developed with oxycodone, a derivative of heroin. Purdue Pharma launched a nationwide marketing campaign promoting a safer alternative to treat pain. The risks were intentionally downplayed or outright hidden.

The SARA reports that prescription opioids were the cause of 200 times more overdoses since the year 2000, and there were 125 million Americans abusing pain medication in 2016. Georgia prescription OD deaths rose from 152 in 2001 to 558 in 2014. From 2009-2014, Georgia had the most “increased encounters related to prescription opioids” — in the entire country.

Thankfully, U.S. Federal courts ordered Purdue Pharma to pay $600 million for “misleading customers about OxyContin’s addictive potential,” and fined three company executives $34.5 billion, one of the greatest fines of a drug company in history. According to FDA Commissioner Dr. Scott Gottlieb, “The practice of over-prescribing opioids helped drive opioid abuse.”

Now oxycontin is sold on the street, as well as morphine, codeine, synthetic pain relievers such as fentanyl, and heroin.

Heroin

Most prescription opioid addicts gravitate to heroin because it produces the same high for a fraction of the price. Urban areas, for the most part, still have the most significant problem with heroin. For instance, the so-called “Heroin Triangle” of Cobb, Gwinnett, Fulton, and DeKalb counties in Georgia, including Atlanta, has a booming heroin market. Prescription pills are hard to get, and often collect as much as $30 per single pill. A bag of heroin will sell for as cheap as $10 and reward the user with the same euphoria.

The rash of heroin overdose deaths in Georgia’s Heroin Triangle Tragedy has exploded by 4,000% from 2010 to 2016 for young people aged 15 to 35. Ther heroin epidemic in Georgia is even causing a heroin addiction in the youth population that has never been seen before. And in no small coincidence, 86% of heroin users begin as prescription opioid users.

Rural Addiction

Besides the family of prescription and illegal opioids, there are many more addictions to consider statewide, and many of those continue to rise in rural areas. Nationwide, small populated regions produce the highest average of alcoholism in Georgia, especially by the youth aged 12-20. Cigarette smoking and smokeless tobacco also have the highest rates in rural areas, as well as methamphetamine.  And of course, several other drugs continue to keep pace with the large metro areas, such as cocaine, crack, and heroin.

Some factors that could contribute to substance abuse in rural areas are:

• • Unemployment

• • Poverty

• • Low education levels

• • High-risk behaviors

• Isolation

There is only so much we know about drug addiction in rural areas, as most research is done by monitoring cases in larger urban areas. But the few studies available reveal many differences between rural and urban drug use, including in variables like age, gender, contexts of drug use, and patterns of health consequences. Other contrasts include different social stressors, unstable income, lower overall health levels, small social networks, a greater stigma around drug use, limited health care access, and sparseness of substance abuse treatment facilities.

Rural users start using drugs at a younger age and are more likely to make and sell meth than their urban counterparts. They also prefer injecting needles as their preferred practice, nearly twice the urban percentage.

Societal Impact

Substance abuse has a variety of effects in Georgia rural counties. Increased crime and violence, vehicular accidents, spreading of infectious diseases like Hep C or HIV (either by sharing a needle or through risky sexual behavior), fetal alcohol syndrome, and homelessness.

Crime can occur several different ways as a result of drug use.

• • Use-Related Crime occurs when the user is under the influence and operates a vehicle, commits domestic violence, or engages in any other crime in an altered state.

• • Economic-related Crimes are committed by the user to fund their habits, such as theft or prostitution.

• System-Related Crimes are related to the production and distribution of illicit drugs and can be violent in nature.

Obstacles to Treatment

Patients in rural areas who need treatment may find they come across many barriers that don’t occur in cities. They might need to travel great distances to treatment centers, for instance, and might not have a car or access to public transportation. The detox centers or behavioral health centers themselves are likely to be underfunded, and their services may be limited. First responders and ER staff often have limited experience providing care for an overdose patient in rural areas, and EMT-trained professionals may be prevented from being allowed to administer naloxone, often given in emergency situations for a heroin overdose. Law enforcement and emergency vehicles may be thin and spread out over a large rural area. Finally, there is the stigma associated with drug use in small towns, and patients who otherwise would seek treatment might be more hesitant.

Solutions

To understand Georgia’s rural drug problem, specific addiction research is needed, along with qualified doctors and preventative education. These are all severely lacking in Georgia’s rural communities.

Prevention programs can be conducted in towns of any size, and are most effective when supported by parents, teachers, church leaders, law enforcement, and healthcare professionals. Communities can work together to create programs that utilize evidence-based strategies and education.

Developing a formal substance abuse strategy for the community can be done by:

• • Holding town hall meetings to raise awareness of the issues.

• • Inviting speakers to schools to help children understand the consequences of substance abuse.

• • Establishing a strong support system for addicts, which could include support groups and hotlines.

• • Routine screening at doctor visits to identify at-risk individuals, including children.

• • Providing transportation to treatment centers and doctor appointments when necessary.

• • Training volunteers to provide support and action in case of an overdose.

• • Provide first responders and emergency room personnel with proper training and access to reversal drugs such as naloxone.

• • Develop special programs to guide a patient through recovery.

• Ensure families affected by substance abuse have adequate food, housing, and mental health services.

These are all very attainable goals for any size community, and once the problem of rural drug use is brought out into the open, work can begin to combat its effects.  

Tobacco

According to the 2016 National Survey on Drug Use and Health, tobacco use for young adults aged 18-25 was as high as 53.7% in completely rural areas, as opposed to 37.6% in metro areas. There are several deterrents available to fight tobacco addiction. Nicotine patches, gum, lozenges, and prescription drugs all help to quit, and education programs and online resources such as smokefree.gov and betobaccofree.gov offer resources and quit-lines that are useful for users looking to quit.

Youth projects like the Truth Initiative work to prevent young people from starting smoking in the first place, and there are organizations that pressure local and state governments to change tobacco policies.

Underage Drinking

Many rural counties are experiencing increases in teenage drinking and binge drinking. Alcohol use in rural areas between 12-20-year-olds is 17.2%, compared to 19.1% in urban areas, yet binge drinking (5 or more drinks for males or 4 or more for females) was found to be 13% in rural areas and 11.5% in urban areas. Heavy drinking (binge drinking 5 or more times in 30 days) was again more prevalent in rural settings, and extreme binge drinking (15 or more drinks) is more common in rural high schools than their urban counterparts.

Getting an early start on alcohol usually results in alcohol abuse as the addict gets older, and more often leads to DUI related accidents and death, all of which are a problem in rural areas. In 2013, nearly half of the 10,000 people in the U.S. who were killed in alcohol-related crashes were in rural areas, and 29% of all rural traffic fatalities involved alcohol.

A lack of treatment services in rural areas is a challenge to foster change, but several communities have begun to add safe-cab and other transportation programs, and alternatives to DUI sentencing to assist offenders to resist driving under the influence.

Family-centered prevention programs can provide support, education, and a line of communication to deter young men and women from addiction. An excellent example of this is the Strong African American Families-Teen (SAAF-T) in rural Georgia, which has proved to be successful in keeping rural youth engaged in school and away from drugs and alcohol.

Working Together

Georgia’s drug problem in rural areas is growing, and communities must be committed to prevention, treatment, and open dialogue to fight addiction. A robust plan based on reliable information and an understanding of the nature of addicts in rural areas can help lead to solutions and progress. Ongoing research on the causes of substance abuse and obstacles to treatment that are contrasting from urban areas, and dedicated funding and resources to enable ongoing support will significantly increase the chances of a healthy community. Working together, rural Georgia counties can one-by-one make drug abuse a thing of the past.

If you or a loved one is suffering from a drug addiction, please call our Georgia rehab center today.

Sources:

Advani, Ashish. “A Drug Problem in Rural Georgia.” KevinMD. 4 Feb. 2018. 5 Mar. 2019. https://www.kevinmd.com/blog/2018/02/drug-problem-rural-georgia.html

“Substance Abuse in Rural Areas.” RHI Hub. 5 Mar. 2019. https://www.ruralhealthinfo.org/topics/substance-abuse

“Country vs. City Addictions: Are They Different?” Drugabuse.com. 4 Mar. 2019. https://drugabuse.com/country-vs-city-addictions-differ-says-samhsa/