As the opioid epidemic continues to rages across most of the United States, lawmakers and other concerned parties remain somewhat clueless as to how to effectively battle the problem. Part of finding a solution is determining the cause, and unfortunately, there’s not a one-size-fits-all answer. According to a new working paper by Shannon Monnat, a Syracuse University sociologist and the Institute for New Economic Thinking, in both urban and rural communities, opioid supply and economic distress are two key factors in predicting opioid deaths but not in equal measures. While addiction doesn’t discriminate in terms of the underlying physiological processes, it does in the sense that the factors that force people into communities at a higher risk of drug addiction aren’t random.


Drug mortality rates are highest in large metro areas, but that doesn’t mean rural areas aren’t experiencing the issue too. In rural counties, the average rate of overdose deaths for 2014 to 2016 is 6.2 fewer deaths per 100,000 people. However, some rural counties, like Central Appalachia, Southwest Pennsylvania and Central Florida, are experiencing higher than average rates while others have lower than average rates, like New York and the Mississippi Delta.


Besides drug availability and economic distress, other economic characteristics like population loss, family distress, and heavy reliance on mining and service industries also contribute to higher mortality rates. When controlling for supply-side factors, a study found that economically distressed areas aren’t more likely to have overdose deaths because they have greater access to opioids. Economic distress in and of itself is a strong determinant of overdose deaths in rural areas. While in urban areas, drug availability is a better determining factor.


This study has significant implications for policymakers attempting to pass legislation to curb the epidemic. If the local economy is struggling, putting limits on opioid prescriptions and trying to stop the sale of fentanyl may do little to actually decrease the rate of overdose deaths.


The opioid epidemic started in the most economically vulnerable parts of the country, and it’s still there that it continues to thrive. Opioids numb both physical and mental pain, meaning areas that have been experiencing an economic and social decline for decades are primed to be the perfect target for addiction.