A new report from Grantmakers in Aging (GIA), “Heartache, Pain, and Hope: Rural Communities, Older People, and the Opioid Crisis,” examines the differential impact of opioid misuse and abuse on older adults living in small towns and rural communities and interventions that provide potential models for scaling up the philanthropic and public response to this crisis. Noting the need for widespread collaboration to address the opioid crisis, the authors write, “Commitment, creativity, ingenuity, and coordination between government, funders, nonprofits, and the medical community will be needed, if we are to make meaningful progress toward meeting the needs, and indeed, saving the lives, of individuals and communities in pain.” For funders and nonprofits, the report profiles a number of best practices that could provide models for successful interventions at the local, regional, or national level.
Extent of the Crisis
In 2015, 52,404 Americans died of drug overdoses. Of these deaths, 63 percent, or just over 33,000, were from opioid use. Nearly half—15,000—were attributed to prescription drugs. (By comparison, 58,000 Americans died fighting in Vietnam.)
Opioid use and misuse has been growing steadily over the last two decades. Since 2000, over 300,000 people have died from overdoses. According to the Centers for Disease Control (CDC), 2 million Americans suffer from opioid use disorder, and another half-million are addicted to heroin. Over four percent of the population over the age of 12—11 million people—report having used prescription painkillers for nonmedical purposes just in the last year.
Rural Communities Hardest Hit
Rural areas of the country have been particularly hard hit by the opioid crisis. Those living in rural communities are twice as likely as urban dwellers to overdose on prescription painkillers. Among the areas experiencing the worst impacts are rural New England, Appalachia, and the Midwest.
The disparate impact of opioid addiction and overdose is due to several factors, according to the GIA report. First, doctors more often prescribe opioids in rural areas. Farmers, miners, and other laborers as they get older often suffer from chronic pain, and have less access to surgery or other medical treatments that might address that pain. “In our area, my dairy farmer has to get up tomorrow morning. He doesn’t have time to go over to Winston-Salem or down to Charlotte for some kind of invasive treatment. So the opioid keeps them going,” explains Fred Wells Brason, founder of Project Lazarus in Wilkes County, North Carolina.
Second, only about 10 percent of opioid addiction treatment resources are located in rural areas. Naloxone (or Narcan), the lifesaving medication that can reverse an overdose, is not only less available but often administered too late as a result of slower emergency response times, as first responders often have to travel long distances. For patients seeking treatment, only 11 percent of those in rural areas receive evidence-based Medication-Assisted Treatment, where a less dangerous opioid, usually buprenorphine, is given to the patient to help them stabilize their life and then eventually end their dependency.
Rural Communities Getting Older
As our country ages, rural communities are aging the most rapidly. One in four adults over the age of 65 lives in a small town or rural area, about 10 million Americans. Many of these older adults suffer from chronic illnesses and pain associated with a lifetime of labor. When opioids are prescribed, insufficient education about dangers associated with these drugs—including overdose and death—can lead to unintended misuse and abuse.
According to the CDC, the Medicare population has among the highest and fastest-growing rates of diagnosed opioid use disorder. There has also been rapid rise in drug overdose deaths among 55- to 64-year-olds, indicating that without intervention, communities will face crisis levels of addiction among older adults in the coming decade.
Nora Volkow, PhD, director of the National Institute on Drug Abuse, explained to GIA, “Baby Boomers’ histories of illicit drug use, and their relatively tolerant attitudes toward it, along with the fact that they now comprise nearly 30 percent of the nation’s population, have raised the stakes on understanding and responding effectively to drug abuse among older adults.”
Impact Goes Beyond Addiction
For older adults, addiction is not the only risk associated with opioid abuse. When younger family members develop addictions, the spillover affe