Substance Abuse in Rural America

Pharmacy Times, March 2017 Central Nervous System, Volume 83, Issue 3

Much of rural America has been inundated with prescription drug abuse for decades. Although this issue continues to plague society, many overdose deaths are now occurring because of polydrug abuse, of which heroin is a major contributor.

I have always lived in rural America, even when working in a city. I prefer rural areas because of their friendly folks with core values and the landscape—open fields, woods, and livestock, mainly beef cattle!

Since April 2016, I’ve had a part-time job commanding the Brown County, Ohio, drug and major crimes taskforce, which needed to be reenergized and expanded. I live just 15 minutes away and was eager to assist. For the past 2 years, Brown County (population: 45,000) has led Ohio in unintentional overdose deaths per capita. With Ohio appearing to lead the country in the number of these deaths, Brown County is a top contending overall leader in this tragedy. At first, I found this almost unbelievable, but then I began to receive almost daily texts regarding overdoses and related deaths in the county. Life squads and emergency medical technicians seem to be constantly busy trying to save individuals with naloxone, whether it be 1 dose or multiple doses.

Brown County has very limited resources, like most rural counties in America, but heroin and prescription drug dealers don’t really care about that. They still find an ample number of addicts who are willing to steal or obtain funds, in any way, to feed their habit. I have long known that law enforcement cannot address these situations alone. In my new job, I quickly found that although sparsely funded, the treatment and rehabilitation folks do their best to fight this seemingly impossible problem.

Much of rural America has been inundated with prescription drug abuse for decades. Although this issue continues to plague society, many overdose deaths are now occurring because of polydrug abuse, of which heroin is a major contributor. In Brown County, overdose deaths of our residents are commonly due to a cocktail of hydrocodone, oxycodone, alprazolam, and diazepam in addition to heroin. Most of this can be traced back to the end of 2010 into 2011, when OxyContin was successfully reformulated to make it very difficult to abuse..

Heroin cartels began to ramp up their deadly product in early 2010 in anticipation of opiate addicts needing a new fix. Their business model was effective, as OxyContin addicts didn’t need to search very far to find a cheap replacement: heroin was less expensive, and abusers didn’t have to scam a doctor and pharmacist—they just had to have cash. Addicts quickly found, however, that the downsides to heroin were its lack of guaranteed purity and that overdosing and dying from heroin laced with fentanyl or carfentanil were strong possibilities. Carfentanil, which is used to tranquilize elephants in zoos, had made its way from China to Mexico to Brown County. Ohio passed a nasal naloxone law to allow law enforcement to administer the live-saving overdose antidote when needed. Without this ability and the work of life squads, our funeral homes would be even busier. Although there will always be critics of this lifesaving drug, it gives addicts a second chance at life.

Because it is about 45 minutes from Cincinnati, Brown County is where most of Ohio’s heroin is purchased, much of it is by addicts who buy extra to supply our residents. Our drug agents have made dents in this supply, but as everyone knows, when one dealer goes to jail, another takes his place. Brown County’s dilemma is not unusual in rural America. However, with our citizens who really care and want to help, and with partners working in treatment, education, and rehabilitation, we will make improvements by attacking the problems from multiple angles. It’s easy to get frustrated regarding opiate abuse and addiction, but rural America needs to keep trying—something rural folks do very well.

Cmdr Burke is a 40-year veteran of law enforcement and the past president of the National Association of Drug Diversion Investigators. He can be reached by e-mail at burke@rxdiversion.com or via the website www.rxdiversion.com.