A surge in Opioid consumption, primarily prescription painkillers, heroin and fentanyl - a drug 50 to 100 times more powerful than morphine - and the resulting spike in overdose related deaths is devastating families in rural America. But the opioid epidemic is laying waste to more than just the broken families it counts among its victims, as Reuters points out today, rural municipalities are finding it nearly impossible to fund the surging costs associated with overdoses which come in the form of emergency call volumes, medical examiner and coroner bills, and overcrowded jails and courtrooms.

As an example, Ross County, Ohio, a town of only 77,000, says its budget for child services has doubled in just 5 years and 75% of the children place into protection come from homes where parents have opioid addictions.

Ross County, a largely rural region of 77,000 people an hour south of Columbus, Ohio, is wrestling with an explosion in opioid-related deaths - 44 last year compared to 19 in 2009. The drug addiction epidemic is shattering not just lives but also stressing the county budget. About 75 percent of the 200 children placed into state care in the county have parents with opioid addictions, up from about 40 percent five years ago, local officials say. Their care is more expensive because they need specialist counseling, longer stays and therapy. That has caused a near doubling in the county’s child services budget to almost $2.4 million from $1.3 million, said Doug Corcoran, a county commissioner. For a county with a general fund of just $23 million, that is a big financial burden, Corcoran said. He and his colleagues are now exploring what they might cut to pay for the growing costs of the epidemic, such as youth programs and economic development schemes.

But it's not just the cost of child services that is wreaking havoc on municipal budgets as everything from autopsy and toxicology costs to court fees and jail expenses are surging throughout rural America.

Autopsy and toxicology costs there have nearly doubled in six years, from about $89,000 in 2010 to $165,000 in 2016, county data shows. Court costs are soaring, mainly because of the expense of prosecuting opioid-related crimes and providing accused with a public defender, local officials say. The county is using contingency funds to pay for the added coroner costs, said Mike Baker, the county’s top government official. Last year, the county drew $63,000 from those funds, up from $19,000 in 2014, he said. In 2014, the county saw 10 drug-related deaths. In 2016, the number had grown to 53. In Mercer County, West Virginia, 300 miles (483 km) to the south of Indiana County, opioid-related jail costs are carving into the small annual budget of $12 million for the community of 62,000 people. The county’s jail expenses are on course to increase by $100,000 this year, compared to 2015. The county pays $48.50 per inmate per day to the jail, and this year the jail is on course to have over 2,000 more “inmate days” compared to 2015, according to county data. “At least 90 percent of those extra jail costs are opioid-related,” said Greg Puckett, a county commissioner who sits on a national county opioid task force. “We spend more in one month on our jail bill than we spend per month on economic development, our health department and our emergency services combined.”

Meanwhile, as Bloomberg has just noted, attorneys general from 41 states are broadening their investigation into the opioid industry and have served subpoenas to five pharma companies that make the most powerful prescription painkillers.

They announced Tuesday that they had served subpoenas requesting information from five companies that make powerful prescription painkillers and three distributors. Forty-one attorneys general are involved. The investigation into marketing and sales practices seeks to find out whether the industry's own actions worsened the epidemic. If the industry cooperates, the investigation could lead to a national settlement. The Healthcare Distribution Alliance said in a statement that it's not responsible for the volume of opioid prescribing but that it does want to work on solving the public health crisis. Dozens of local and state governments have already filed, announced or publicly considered lawsuits against drugmakers or distributors.

To add some context to the scale of the opioid epidemic, the California Department of Public Health recently dropped some staggering statistics showing that there are a remarkable number of counties in California where annual prescriptions for pain killers actually exceed the population.

Trinity County is the state’s fourth-smallest, and ended last year with an estimated population of 13,628 people. Its residents also filled prescriptions for oxycodone, hydrocodone and other opioids 18,439 times, the highest per capita rate in California. Besides Trinity, other counties with more prescriptions than people include Lake, Shasta, Tuolumne and Del Norte counties. In the Sacramento region, El Dorado, Placer and Sacramento counties had prescription rates above the statewide average, with Yolo County slightly below the state average. A county’s prescription total represents all opioids dispensed via prescriptions filled at a pharmacy and tracked by the state. Statewide, 15 percent of Californians were prescribed opioids in 2016, ranging from 7.3 percent of residents in tiny Alpine County to almost 27 percent in Lake County.

As might be expected, the scripts per capita are highest in California's more rural northern counties.

So who is participating most in this deadly epidemic? Well, according the Centers for Disease Control and Prevention, the biggest abusers of opioids are high-school educated, unemployed, white people living in small towns...

“The following characteristics were associated with higher amounts of opioids prescribed: a larger percentage of non-Hispanic whites; higher rates of uninsured and Medicaid enrollment; lower educational attainment; higher rates of unemployment; (small-town) status; more dentists and physicians per capita; a higher prevalence of diagnosed diabetes, arthritis, and disability; and higher suicide rates,” concluded the authors of a Centers for Disease Control and Prevention study released in July. “What you’re seeing in California is what you’re seeing in many parts of the country, including Oregon,” Korthuis said. “There are still a lot of rural counties around the U.S. that are awash in prescription opioids.”

Of course, growth in opioid addiction is hardly just a California phenomenon. According to the CDC's Annual Surveillance Report of Drug-Related Risks and Outcomes, addiction-related deaths are far more prevalent in the rural 'rust-belt' states of the Midwest.

Meanwhile, the epidemic is growing far more severe every year with overdose deaths up 167% across the country since 1999.

The rate of drug overdose deaths increased from 6.1 per 100,000 population in 1999 to 16.3 in 2015; for unintenttional drug overdose deaths, the rate increased from 4.0 per 100,000 in 1999 to 13.8 in 2015; for drug overdose deaths involving any opioid, the rate increased from 2.9 per 100,000 in 1999 to 10.4 in 2015 (p<0.05); for unintenttional drug overdose deaths involving any opioid, the rate increased from 2.1 per 100,000 in 1999 to 9.3 per 100,000 in 2015 (p<0.05). For all four categories of drug overdose deaths, increases in rates were largest from 2013 to 2015, with the rate increasing on average by 9% per year for overall drug overdose deaths (p<0.05), 11% per year for unintenttional drug overdose deaths (p<0.05), 15% per year for drug overdose deaths involving any opioid (p<0.05), and 16% for unintenttional drug overdose deaths involving any opioid (p<0.05).

But don't worry too much because, as Princeton Economist Alan Krueger told us recently, there is a simple solution to the opioid epidemic in the U.S...apparently it can all be solved with just a little more Obamacare.