By now we have heard that there is an opioid crisis in the United States. Maybe we’ve read some articles about it, but do we know how devastating it really is? Do we know how tenacious the problem is, specifically for rural America? And do we know what we can do about it?
The Centers for Disease Control and Prevention (CDC) defines opioids as a “class of drugs used to reduce pain.” The most well-known are morphine and heroin, but many others are used legally and illegally throughout the world. The United States has seen a sharp increase in use and abuse in recent years, and rural areas have seen the most devastating increases.
Western Michigan, where I live, contains elements of city, small town, and rural life. We are not removed from this reality and the numbers show it: an 85 percent increase in opioid-related deaths from 2015 to 2016 in our small West Michigan county.
Of course, opioid-related deaths are nothing new. For years we have seen this happen. We lost someone close to our church community several years ago. We know close family members and friends who have overdosed or suffer the effects of vicious addiction cycles. Sadly West Michigan is not even the epicenter of the crisis.
2015 was the deadliest year on record for opioids in the United States, according to the CDC. On average, 91 people died every day in the United States from an opioid overdose. Ninety-one lives lost. Every day. The epidemic crisscrosses the whole country.
It is important to understand not only the extent of the epidemic, but also to understand why it hits rural communities so hard. Why do opioids especially hurt rural America?
Rural communities usually have fewer resources to combat opioid addiction. Oftentimes they are not able to choose alternatives to pain medication, such as physical therapy, which means more opioid prescriptions. And opioid prescriptions too often lead to opioid addiction. According to the CDC, three out of four new heroin users report abusing prescription opioids prior to trying heroin. The opioid crisis is not primarily caused by the flood of illicit drugs to the market. Prescription opioid painkillers have formed a surging gateway to opioids of all kinds.
Social factors then speed up the process of opioid addiction. People in rural areas have sprawling social networks that give them wide access to prescription-prone doctors or friends who sell drugs. In recent years, rural communities have also lagged behind urban centers in economic growth and investment. This puts a strain on many people and leads to higher rates of drug abuse. The economic struggles in rural areas also affect which doctors set up practices and which resources those doctors have at their disposal. Even when people seek treatment, the options are much more limited in rural areas—doctors are less likely to be licensed to prescribe treatments and distribution centers can be burdensome to find. Even in under-resourced urban areas, someone with an addiction is likely to live in closer proximity to the clinical help needed to manage their addiction than someone fighting the same addiction in a rural community. Despair, geography, social networking, medical resources—it all exacerbates opioid addiction in rural areas.
The rural opioid crisis is a unique and almost intractable problem. Almost. There are hopeful avenues for turning the epidemic around. But it will take an almost unprecedented level of collaboration between government and civil society to work toward solutions for a part of the country we too often forget or even demonize.
A Public Justice Response
To tackle this problem, we must begin on the most basic level: leveraging the very social networks that help the epidemic spread so virulently in the first place. The relationships that bind rural communities are the strongest asset in this battle. Loving family, friends, pastors, social workers, and others can step in and work to dam the channels of drug abuse. Social networks can provide emotional support, combat stigma, and reframe the community as one of health instead of destruction. This could look like hosting a family support group at a church or establishing a network of recent retirees who offer rides to people struggling with transportation to treatment centers. If we can tighten the web and organize more to take this head on we can go a long way in dismantling these cycles.
Concerned citizens cannot do it alone. They need doctors who have more training and accountability. The vast majority of doctors want to do their part, but many need more resources to do it. Businesses, medical providers, and regulators will need to coordinate to provide money for training in prevention and treatment. This could allow doctors themselves to organize better and coordinate their work through professional networks. We often fail to bring medical professionals to the table to hear what they need on the ground to transform their practices.
This kind of change will not succeed unless there is also support from local and state governments. Regulations may need to be tightened or loosened, including reevaluating the privacy restrictions that clinicians wave if they are certified to prescribe Suboxone, a treatment drug. Grants will need to be made available. A place to start there may be programs to attract physicians to rural areas. Any considerations like these will require hard conversations between various stakeholders and community leaders. This will take a certain amount of courage from elected officials. It is much more visible and politically convenient to invest in a booming downtown or city center than an addiction clinic somewhere most people haven’t heard of. Local governments hold a lot of power over these issues. Are we encouraging these elected officials to address the crisis in a real way? Or are we still only advocating for a new dog park or cool brewery? That’s not to say these investments are bad in any way, but the current reality is that economic opportunity is frightfully low in many rural communities. It may be time to give attention to creative solutions. Our rural communities need more economic growth.
Rethinking Drug Policy
Local governments also need support from federal policy. This can come in the form of smart grants. It can come from federal coordination across state lines. It is also important that our drug laws pursue restorative justice. It is concerning that our opioid epidemic has reached crisis levels at the same time the White House has proposed gutting the Office of National Drug Control Policy and Attorney General Jeff Sessions has encouraged prosecutors to return to a policy of pursuing charges that have mandatory minimums.
Sessions’ memo has a lot to do with shifting power away from judges and back toward prosecutors. That trend, when applied to drug offenses, is not a harbinger of human flourishing for these rural communities who are already suffering. The problem will not be solved by locking up certain drug offenders with longer sentences. Now is the time to prioritize the well-being of communities over appearing to be “tough” on drugs. Of course, this doesn’t mean we leave the rule of law behind. It means that elected officials have the opportunity to pursue laws that truly seek human flourishing and not just a “tough on crime” image. This will take a great deal of listening on the part of federal officials—listening to the solutions of everyone from doctors to law enforcement officials.
From local social networks to White House policies, there are ways to combat the opioid epidemic. That is the good news. However, it will take massive coordination, political will, and citizen engagement at all levels to successfully address it. Some believe that this epidemic has not hit rock bottom yet. Lord, have mercy. Yet we have before us tools and strategies that can stem the tide and lead some of these communities into the shalom that God desires for them.
-Dan Carter is a husband, father, neighbor, reader, runner, and Senior Pastor of Calvary on 8th St. located in Holland, MI.