For nearly as long as we’ve been hearing about the opioid epidemic, we’ve been told that the crisis is worse in rural areas. And it’s true – according to the Centers for Disease Control and Prevention, Americans who live in rural communities are more vulnerable to prescription painkiller abuse and overdoses. Unbelievably, despite only 20 percent of Americans living in rural areas, the rate of opioid-related overdose deaths in rural counties is 45 percent higher than in urban counties. What’s the explanation? One frequently repeated opinion is that in places like Appalachia, there are few jobs and fewer opportunities for improvement, and people turn to drugs to dull their financial woes. There’s a term for the overdose deaths that occur as a result of these kinds of troubles – deaths of despair. The term was originally borrowed from an economics paper, and refers to death by drugs, alcohol, and suicide. However, recent research suggests that the link between economic hardship and opioid abuse may not be as strong as previously thought.

A working paper published in January 2018 by the National Bureau of Economic Research suggests that economic conditions explain less than 10 percent of the rise in drug overdose deaths between 1999, which was near the beginning of the opioid crisis, and 2015, the last year with available applicable data. The study’s author looked at five economic measures: poverty rates, median household incomes, home prices, unemployment rates, and import exposure. These deaths of despair don’t necessarily have to be economic, either, according to the paper. Even that 10 percent, the writer argues, might be attributable to other things that coincide with low income, like lack of education.

There is conflicting evidence on the role education plays in addiction. Many experts say that people with higher education are less likely to develop substance use disorders, because they are equipped with the tools to deal with life. For one thing, they are more likely to have a higher income, which means less financial stress and more access to health care. The more educated someone is – although there are certainly exceptions to this rule – the less likely they are to have debilitation mental illnesses that might lead to substance abuse.


Some of the other factors in these deaths of despair might be completely or only tangentially unrelated to economics. For example, many people in Appalachia work in mines or similar labor-intensive fields. These are dangerous jobs, and injuries are common. It only stands to reason that a significant percentage of severely injured people would end up addicted to opioids. It also follows that they would develop depression and suicidal thoughts if their quality of life was impacted – such as if they found themselves unable to work again.

If you or a loved one need help with quitting drugs or alcohol, consider Asana Recovery. We offer medical detox, along with both residential and outpatient programs, and you’ll be supervised by a highly trained staff of medical professionals, counselors, and therapists. Call us any time at (949) 438-4504 to get started.