Why the Rural Opioid Crisis Is Different From the Urban One

In 2017, opioid overdose deaths in the U.S. reached a record high. And mayors and local leaders across the country have been scrambling to figure out what’s driving this precipitous rise of opioid mortality in the last two decades. Several theories have been aired, from aggressive Big Pharma marketing to anxiety among Baby Boomers. Unfortunately, no one-size-fits-all answer exist—how and why this public health problem manifests locally varies greatly across the U.S..

That’s according to a new working paper by Syracuse University sociologist Shannon Monnat and the Institute for New Economic Thinking (INET). It finds that one narrative that gained steam after the 2016 election—the notion of the modern opioid crisis as a disproportionately rural phenomenon that emerged outside of the cities where the “War on Drugs” has been raging for more than three decades—doesn’t hold up. Instead, in both rural and urban communities, two key factors—economic distress and supply of opioids—predict the rate of opioid deaths.