The prescription medicine overdose epidemic that's become a leading cause of death in the U.S. may have its roots in Appalachia, but has spread across much of the country in recent years.
A new county-level analysis of drug poisoning deaths published online this week in the American Journal of Preventive Medicine shows that while the problem has sometimes been portrayed being more common in rural areas, death rates have actually soared in rural areas and urban centers.
Researchers from the Centers for Disease Control and Prevention note that drug poisoning has increased by more than 300 percent over the last three decades, mainly from unintentional overdoses of narcotics, hallucinogens and other drugs.
According to the National Survey of Drug Use and Health, about 2.1 percent of Americans say they've taken prescription painkillers for non-medical reasons within the past month.
The Food and Drug Administration estimates that retail pharmacies filled about 174 million prescriptions for intermediate and extended-release opioid pain relievers in 2002. By 2009, the number increased to nearly 257 million.
The new study used special tools to analyze small areas and produce estimates of drug-related deaths at the county level.
The researchers found that in 1999, only three percent of counties had annual drug poisoning (age adjusted) death rates greater than 10 per 100,000. But by 2008-09, 54 percent of all counties were experiencing such death rates.
Very high death rates (greater than 29 per 100,000) were spread across much of the country by 2008-09, including Alaska, Hawaii, the Pacific region, New Mexico, Oklahoma, Appalachia, the coasts of Louisiana and Mississippi, Florida and throughout New England.
While drug poisoning rates increased across all geographic areas, there was a greater percentage increase for rural areas (394 percent) compared to large metropolitan counties (297 percent).
This suggests that both urban areas and rural areas saw similar absolute rates of increase in drug deaths between 1999 and 2009, but that since rural areas started out substantially lower than cities, the percentage increase rural areas was larger over time, said Lauren Rosen, the lead investigator.
Another study by researchers at Indiana University and Purdue University, found another geographic indicator for likely prescription pain reliever abuse in Indiana.
They found that the more health care providers, particularly dentists and pharmacists, a county has, the greater the availability of the drugs and higher rates of abuse. The study was presented Nov. 5 in Boston during the annual meeting of the American Public Health Association.
Another report, from researchers at Johns Hopkins University, found that even as prescription opioid use has soared, the treatment of pain has failed to improve.
They reviewed national surveys of patients being treated outside hospitals between 2000 and 2010 and found that there had been no significant change in the proportion seeking treatment for pain.
The researchers found that while analgesic (non-opioid) prescriptions held steady over the decade, morphine-related prescriptions nearly doubled. Of roughly 164 million pain visits reported for 2010, about half were treated with a pain-relieving drug - 20 percent with opioids and 27 percent with non-opioids.
Writing in the journal Medical Care, they noted that not only have rates of treated pain not improved, but that use of safer medicines like ibuprofen and acetaminophen have either stayed flat or declined.