Drug OD Rate Now Higher in Rural U.S. Than Cities: CDC

Hardest-hit communities need targeted preventive measures, report suggests

By Robert Preidt

Friday, October 20, 2017

FRIDAY, Oct. 20, 2017 (HealthDay News) -- Drug overdose death rates in rural areas of the United States are now higher than in cities, a trend that worries federal health officials.

In 2015, drug overdose was the leading cause of injury-related death in the United States -- with 52,000 fatalities attributed to opioid painkillers, heroin and other potentially deadly drugs, researchers said in a new report.

U.S. Centers for Disease Control and Prevention Director Dr. Brenda Fitzgerald said rising overdose death rates outside metropolitan areas warrant attention.

"We need to understand why this is happening so that our work with states and communities can help stop illicit drug use and overdose deaths in America," Fitzgerald said in an agency news release.

In 1999, drug overdose death rates were 6.4 per 100,000 in urban regions and 4 per 100,000 in rural areas. But the gap gradually disappeared. By 2015, the rate was 17 per 100,000 in rural areas and 16.2 per 100,000 in cities, the study findings showed.

The researchers assessed illicit drug use and disorders from 2003 to 2014, and drug overdose deaths from 1999 to 2015 in urban and rural areas. The investigators were led by Karin Mack of the CDC's National Center for Injury Prevention and Control.

Although the percentage of people reporting illegal drug use is actually lower in rural areas, the effects appear to be greater, the researchers noted.

Overall, "most overdose deaths occurred in homes, where rescue efforts may fall to relatives who have limited knowledge of or access to life-saving treatment and overdose follow-up care," the authors explained in the news release.

Looking at where drug users live and where they die from overdoses might lead to better preventive measures, the team pointed out.

Some other findings in the report:

Rising rates of drug overdose deaths nationwide between 1999 and 2015 were consistent across gender, race and intent (unintentional, suicide, homicide or undetermined).
The actual number of drug overdose deaths remains much higher in cities. In 2015, about six times as many drug overdose deaths occurred in urban areas (45,059) as in rural areas (7,345).
The percentage of people reporting use of illicit drugs in the past month fell among those aged 12 to 17 over a 10-year period, but rose sharply in other age groups.
On a positive note, past-year illicit drug use disorders declined during 2003-2014.

"On the one hand, the decline in illicit drug use by youth and the lower prevalence of illicit drug use disorders are encouraging signs," Mack's team wrote. "On the other hand, the increasing rate of drug overdose deaths in rural areas, which surpassed rates in urban areas, is cause for concern."

Since rural residents are less likely to have access to substance abuse treatment services, the findings point to a need to beef up such services outside cities, the authors of the report said.

Moreover, doctors should be updated on guidelines for prescribing opioids for chronic pain. And communities with high opioid-use disorder rates might benefit from greater access to addiction/overdose treatments such as methadone, buprenorphine or naltrexone, Mack and colleagues concluded.

The findings were published in the Oct. 20 issue of the CDC's Morbidity and Mortality Weekly Report.

SOURCES: U.S. Centers for Disease Control and Prevention, news release, Oct. 19, 2017; Oct. 20, 2017, Morbidity and Mortality Weekly Report

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