ARI SHAPIRO, HOST:
Heroin and prescription painkillers are fueling a rise in overdoses around the country, and research shows rural areas are particularly at risk. From Colorado, Luke Runyon of member station KUNC has this on the connection between rural life and opioid addiction.
LUKE RUNYON, BYLINE: Melissa Morris got her first prescription when she was 20. She had a C-section, and her doctor sent her home with Percocet. She took one and laid down on her bed.
MELISSA MORRIS: And I remember thinking to myself, oh, my God, is this legal? How can this feel so good?
RUNYON: She was hooked. Soon after, she started taking the pills recreationally, shopping around for doctors who'd write new prescriptions.
MORRIS: It starts out Vicodin, Percocet.
RUNYON: Then it was Oxycontin, then the highly addictive and potent Fentanyl.
MORRIS: And then it's heroin. That's the holy grail.
RUNYON: Morris started stealing to fund her addiction, then got into the drug trade herself, raising money to buy more heroin.
MORRIS: And you can buy a gram of heroin for 50 bucks, and it'll last you five days longer. So that's why so many people here have turned to heroin.
RUNYON: Morris lives in Sterling, Colo., a two-hour drive east of Denver out on the plains. About 14,000 people live here. A state prison is the top employer. And since 2002, the death rate from opioid overdoses in this county has nearly doubled. And it's not just Sterling. According to the Centers for Disease Control and Prevention, the number of deaths nationwide in which opioids were involved quadrupled over the last 15 years. And the death rates are rising fastest in rural areas.
JACK WESTFALL: The number one issue we're facing is opioids.
RUNYON: Jack Westfall is a family physician and researcher at the University of Colorado. He works with a network of rural clinics and hospitals in the state.
WESTFALL: We don't know what to do with this wave of people who are using opioids. They're in the clinic. They're in the ER. They're in the hospital. They're in the morgue because they overdose.
RUNYON: But what's causing the spike? University of California Davis epidemiologist Magdalena Cerda says a mix of risk factors has made rural America more susceptible to opioid addiction. In the economic recovery after the 2008 recession, rural counties consistently lagged behind cities, losing jobs and population.
MAGDALENA CERDA: You have a situation where people might be particularly vulnerable to perhaps using prescription opioids to self-medicate a lot of symptoms of distress related to sources of chronic stress, chronic economic stress.
RUNYON: Cerda also says the specific types of jobs more prevalent in rural areas - like manufacturing, farming and mining - tend to have higher injury rates, leading to more pain and, in turn, more pain killers. Other research points to the unique social structures in rural America as a potential cause.
KIRK DOMBROWSKI: One of the things that I think probably is counterintuitive to most of what we think of as a small town is that rural people actually have much larger social networks than urban people.
RUNYON: Kirk Dombrowski is a sociologist at the University of Nebraska-Lincoln. He says rural people have more friends and family in similar situations.
DOMBROWSKI: And that gives them more opportunities to know where to get drugs, and so some of those social factors of being in a small town can definitely contribute.
MORRIS: This is what the wrapper looks like.
RUNYON: Back at her home in Sterling, Melissa Morris takes a small piece of orange film out of her purse.
MORRIS: And then you put it on your tongue and you let it dissolve there.
RUNYON: Morris stopped using heroin four years ago and now depends on Suboxone, a less potent opioid used to wean people off heroin. It's in short supply in many rural communities, in part because few rural doctors have gone through the required training to prescribe it. Morris drives to a clinic two hours away to pick hers up. She recently introduced two friends, also addicted to opioids, to the clinic she goes to weekly for treatment.
MORRIS: I used to sell them pills and heroin and stuff. So I do have hope because I've seen success stories.
RUNYON: That strong connection among small-town residents could be part of what spread the opioid epidemic. But it could also be what helps to fix it. For NPR News, I'm Luke Runyon in Sterling, Colo.
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