What's Behind The Geographical Disparities Of Drug Overdoses In The U.S.

Opioid overdose deaths are more common in the eastern United States. NPR's Ailsa Chang talks with journalist Beth Macy about this geographic disparity.

MARY LOUISE KELLY, HOST:

OK, back now to our top story on life expectancy.

AILSA CHANG, HOST:

One thing the new CDC report makes clear is that you are more likely to die from a drug overdose in some parts of the country compared to others. If you look at the CDC's map of where drug overdoses have happened, they're concentrated east of the Mississippi River. To understand why these geographical disparities are happening, we're joined now by journalist Beth Macy. She's been studying the opioid crisis for years and is the author of a recent book called "Dopesick," which focuses on how the crisis began in Appalachia. Welcome back to the program, Beth.

BETH MACY: Great to be back. Thanks, Ailsa.

CHANG: Why are people dying more often of opioid overdoses in the eastern part of the U.S. compared to the western part? What do you think?

MACY: Well, we have more of a fentanyl problem in the eastern part of the United States. You've heard of black tar heroin, which is largely a Western United States phenomenon, and that is less likely to have fentanyl in it. Fentanyl is way more powerful than heroin - 50 to 100 times more powerful.

And you're particularly seeing upticks in overdose deaths in places where we haven't gotten our arms around harm reduction and where we haven't gotten our arms around medication-assisted treatment and syringe exchanges - all the things that we know, because science tells us and the national institutes of drug abuse tell us, are the best ways to treat this disorder.

And particularly in rural areas near - like Appalachia, which is not far from where I live, you have a real dearth of housing options, transportation, jobs. And it's just much more of people dying not just because they're coming into contact with fentanyl, but also they're dying from these diseases of despair.

CHANG: What do you mean by that?

MACY: Well, that is a phrase that comes out of the groundbreaking study that came out in 2015 by the Nobel-winning economist Angus Deaton and his wife Anne Case. And that was showing that, for the first time in American history life expectancy was actually going down, and, you know, that's what we're seeing today. It's now the third year of that.

And what they're looking at is alcohol-related deaths - cirrhosis. They're looking at suicides. They're looking at largely drug overdoses - mostly opioid overdoses. And when I think about that, I think about some of the people in my book "Dopesick." So I think of one man in particular. He was the town maintenance manager of Big Stone Gap, you know, right in the heart of central Appalachia.

And he was trying so hard to get better, but because of the stigma out there against medication-assisted treatment, you know, he was not able to get access to that. And when he relapsed, rather than - which, you know, we know opioid use disorder is a chronic relapsing disease. He relapsed. And rather than face his family - he was so ashamed of it, he went into the woods and he killed himself.

CHANG: Do you think the worst is over in your region? Has the crisis leveled off or even improved there?

MACY: That's such an interesting question. I was just in a seminar on the phone with a bunch of public health experts from Appalachia two days ago, and we were asking the same question. We are starting to see five counties in eastern Kentucky, which is really the heart of central Appalachia, starting to have reduced overdose deaths. And one of the public health deans from the University of Pittsburgh, Don Burke, said, you know, I think it's possible that we've hit saturation in that region.

CHANG: Saturation, what an interesting word.

MACY: Saturation. But honestly, I had five or six of the smartest people I know on this issue on the phone - on this seminar with me, and nobody was exactly sure. So it's a puzzle.

CHANG: Beth Macy is the author of the book "Dopesick." Thank you very much for joining us again today.

MACY: Thanks so much, Ailsa.

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