Growing Accessibility of Opioids in Rural Areas

A recent Kaiser Health News article shed light on one business that is thriving in some poorer, rural towns: pharmacies. Specifically, it highlights Manchester, KY, a town of 1,500 in Clay county. Despite dilapidated infrastructure and empty storefronts, drug stores continue to open. Three in the past four years gives the town a total of eleven drug stores. Their best sellers are prescription pain drugs.

To put it in perspective, in a 12-month period 2.2 million doses of hydrocodone and 617,000 doses of oxycodone prescriptions were filled. In a county of 21,000, that’s 150 doses for every man, woman, and child. In some areas, Clay county’s doses are 100 percent higher (sometimes more) than nearby counties of similar size. From 2009 to 2013 Clay county also had the third highest rate of hospitalizations for pharmaceutical opioid overdoses among Kentucky’s 120 counties.

Adults with poor or fair health are more prevalent in Clay county than many counties of similar size, specifically Allen and Breckinridge. Obesity and diabetes in these areas are also higher than the state and national averages.

Areas like Clay county aren’t only disadvantaged in terms of health, but economically as well. The unemployment rate is above the national average at 8.4 percent, nearly half of the residents live below the poverty level, and 60 percent of residents are on Medicaid. Hardships like poverty, unemployment, and feeling isolated can make the use of substances, like opioids, more attractive. As the Kaiser article points out, one key predictor of prescription drug abuse is social ranking.

The opioid epidemic that’s sweeping the country, especially rural America, has been well noted. And while there is a growth in legal ways to obtain prescription pain, in part due to the Medicaid expansion, Dr. Jeffrey Newswanger, an ER physician and chief medical officer at Manchester Memorial Hospital, believes that most people who abuse prescription drugs acquire them illegally. “We see a lot of overdoses and have a tremendous drug problem in the area,” he said.  “Whether there is any correlation between OD’s and the Medicaid expansion is hard to say. I think in general most abusers are getting their drugs from the street, not from prescriptions.”

A lot of focus is on Kentucky, but there are even more startling stories just across the border in Mingo county, West Virginia. In Kermit, a town of 392 residents, drug companies shipped 9 million hydrocodone and oxycodone pills to one pharmacy over a two-year period. And in a six-year period 780 million hydrocodone and oxycodone pills were distributed throughout the state- in the same period 1,728 West Virginians overdosed on those same drugs. Meanwhile the CEOs of the big three wholesalers that shipped the drugs to West Virginia were compensated a collective $450 million over four years. You can find additional reading, maps, and data on opioid prescriptions and use in West Virginia, here.

Many living in rural areas lack basic access to substance abuse treatment services. Nearly 82 percent lack access to detox services. Those who need more advanced services have to travel long distances to reach the specific services they need. That can be especially burdensome for disabled patients who do not drive or do not have access to public transportation. And in places like Manchester, KY, the closest inpatient drug treatment facility has a waiting list of 100 people. The waiting list has grown by 50 percent just within the past few years and has been at capacity for the past several.

Frontline health care employees in many rural areas do not have the resources or specialized training to treat the growing substance abuse epidemic- especially in the face of a growing number of pills that are acquired both legally and illegally.

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