Highlights

• A new study in the Journal of the American Medical Association (JAMA) looks at geographic trends in opioid overdoses in the United States.
• The study used a COVID-19 outbreak prediction model to determine where opioid-involved deaths will escalate.
• Data from 2020 shows the worst-ever rates of opioid-involved overdose deaths, an acceleration that signals ‘explosive exponential growth that is even larger than an already historic high.’

Since 1999, geography has played a role in where opioid-involved overdose deaths have occurred, reports a new multi-institution study led by Northwestern University. However, findings suggest a newly identified “fourth wave” will not discriminate between rural and urban areas.

Key to this discovery was a method developed during the early days of the COVID-19 pandemic to predict outbreaks by geographical area. The study’s lead researcher, Northwestern’s Lori Post, had previously collaborated with Charles Moss, a professor in the University of Florida’s food and resource economics department, to develop the COVID-19 outbreak prediction tool.

“We were able to apply the model created for predicting COVID-19 outbreaks and translate that to the opioid crisis,” said Moss, who, along with Post, was the recipient of a United States Department of Agriculture grant that enabled his involvement in the latest study. “Now that we have this methodology, we should be able to apply it to other geographic trends that may arise.”

The modeling techniques allowed the researchers to identify new variants, predict exponential growth and determine where on the epidemiological curve the outbreak sits, Post said.

In addition to the USDA funding, Post also secured grants to complete the 21-year opioid study from the National Center for Advancing Translational Sciences, part of the National Institutes of Health, and the Northwestern University Clinical and Translational Sciences Institute (NUCATS).

Post said study findings indicate a concerning trend among opioid-involved deaths.

“I’m sounding the alarm because, for the first time, there is a convergence and escalation of acceleration rates for every type of rural and urban county,” said Post, director of the Buehler Center for Health Policy and Economics at Northwestern University Feinberg School of Medicine. “Not only is the death rate from an opioid at an all-time high, but the acceleration of that death rate signals explosive exponential growth that is even larger than an already historic high.”

First study to look at acceleration rates systematically by geography

According to the study authors, no previous study to their knowledge has examined acceleration rates of opioid-involved overdose death (OOD) rates systematically by geography for every year.

Post said that usually when OOD rates in rural areas were higher, they were lower in urban areas, and vice versa. Since 2019, both have reached an all-time high and have an all-time high acceleration rate. “We have the highest escalation rate for the first time in America, and this fourth wave will be worse than it’s ever been before,” Post predicted. “It’s going to mean mass death.”

Rural healthcare gap

Among the challenges rural populations face, access to healthcare is a notable barrier, particularly when it comes to overdose treatments that require emergency attention.

Study results show that near the end of available data in 2020, OODs in rural areas were escalating faster than in urban areas. As an agricultural economist, Moss’s research focuses on how opiate misuse impacts rural communities and the agricultural economy in the United States.

“Regardless of the driving factors, the opioid crisis is most likely to affect agriculture through its impact on the rural labor market,” Moss said. “We envision two potential consequences: First, the opioid crisis could reduce the supply of labor available to agriculture – one indication that this has occurred is a decline in the labor participation ratio; a second possibility is that the quality of labor has declined due to the growth in opioid abuse.”

What can be done?

One support resource may be methadone or buprenorphine centers, Post said, which offer medication-assisted anti-addiction treatments for heroin or synthetic and semisynthetic opioid abusers. However, they are typically only opened in urban areas. Rural areas have no medication-assisted treatment options, she said, adding that what works in large cities is likely not as useful for rural areas.

“The only path forward is to increase awareness to prevent opioid use disorders and to provide medication-assisted treatment that is culturally appropriate and non-stigmatizing in rural communities,” Post said.

The study, “Geographic Trends in Opioid Overdoses in the U.S. From 1999 to 2020,” can be accessed at jamanetwork.com/journals/jamanetworkopen/fullarticle/2794742.

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