Drugs in The Tennessee Hills: The Appalachian Opioid Crisis

The Facts of the Epidemic

The nexus of America’s opioid epidemic isn’t where most people would expect. It’s not in New York, New York or Los Angeles, California – instead, the hub is in the rural Appalachian region: a mountainous area extending from northern Alabama through Tennessee, Georgia, North Carolina, Kentucky, Virginia, Ohio, and Pennsylvania.

Sky-high rates of substance use and overdoses in this region can be attributed to a multitude of factors, including economic depression, high unemployment rates and low access to care. As researchers learn more about these factors and events, disturbing trends emerge:

  • Overdose mortality rates for people aged 25-44 (those in their prime working years) are 70% higher than the rest of the country.
  • Overdose mortality rates for people for aged 15-64 are 65% higher in Appalachia than the rest of the country.

In addition to rigorous, peer-reviewed accumulation of data, local and federal agencies are working together to get a full picture of the Appalachian opioid crisis. Today, we’ll discuss a groundbreaking effort to gather anecdotal perceptions of the epidemic.

Local Perception

In a report titled, “Communicating About Opioids in Appalachia: Challenges, Opportunities and Best Practices,” the Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), the Appalachian Regional Commission (ARC) and Oak Ridge Associated Universities (ORAU) worked together to delve deeper into local perception of the Appalachian opioid epidemic. Over the course of six months, the organizations conducted interviews and formed focus groups to learn more about opioids in the region.

The project had two specific goals:

  1. To explore how the opioid crisis is uniquely affecting diverse Appalachian communities
  2. To identify effective content and messaging strategies that would benefit Appalachian community-based organizations in their efforts to prevent and treat opioid misuse.

The authors note that this document serves as a reflection of local beliefs and understandings – it is not intended to supplant statistical data from research literature. Because of its anecdotal ties, the report provides fascinating insight to the mindset of those in these communities. We’ve selected some of our key takeaways below.

Economic Decline and Lack of Opportunity

Perhaps most impactful was the discussion of economic decline and lack of employment opportunities as contributing factors to (and byproducts of) Appalachia’s opioid crisis. Those surveyed cited personal stories about the number of opioid misuse cases in their communities skyrocketing after the closure of plants, mines and other large businesses. With unemployment on the rise, formerly productive individuals were believed to become anxious or depressed, turning to opioids in an effort to “self-medicate.”

Children and Young Adults

Some community members said that the high rate of government assistance was to blame, while others pointed to the high rates of multi-generational addiction and adverse childhood experiences. One community member in Kentucky said, “You’ll ask [a child], ‘What do you want to do when you grow up?’ And they say ‘nothing.’ So you ask, ‘Well what does your dad do?’ They answer, ‘nothing.’”

These children grow up watching addiction in the home. As such, they become desensitized to this behavior and begin taking drugs themselves at very young ages. It is not uncommon for children in such families to internalize the harmful lessons learned at home. One person surveyed said that children in their community frequently learn to count in “quantities and milligrams,” while another described kids “snorting smarties in the bathroom.” Experts consider multi-generational addiction to be a part of adverse childhood experiences, which contribute to trauma and increased risk of future substance use.

Appalachian Attitudes About Addiction

While many participants believed the region’s opioid crisis to be well-known, this did not translate to regular discussions on the topic within the community. This means that while town halls and news stories attempt to begin a dialogue about drug use, actual community members are not discussing the issue at work, church or school.

This can ultimately be attributed to extremely high stigma within Appalachia, more so than a genuine apathy or lack of information. One participant described opioid addiction as “the new leprosy,” which aligned with descriptions by others of judgmental attitudes from law enforcement officers, city officials and healthcare providers.

For this reason, increased education and grassroots efforts to dispel stigma are especially important. Those in the area should seek to change attitudes surrounding addiction.

Access to Healthcare Services

Preventative efforts and treatment services are often absent or insufficient in the Appalachian region. These include non-narcotic alternatives to pain management (physical therapy, cognitive-behavioral therapy and acupuncture) and local, affordable programs for the treatment of opioid addiction. The importance of prevention efforts, they say, is not understood by a majority of local decision-makers (such as politicians). The pervasive belief is that these individuals would rather see a “quick fix” than preventative care and education.

Those surveyed felt that individuals would be better able to recover in the long term if armed with coping mechanisms and ongoing support within their own communities. People in recovery told stories of struggling to find help, sometimes only being able to access care after an arrest and sentencing of court-mandated treatment.

Help for Appalachians

At Cumberland Heights, we understand the unique struggles of Tennesseans dealing with opioid addiction. This issue is described as an epidemic because it can be completely devastating to one’s health and wellbeing. If you’re looking for help, we’re here for you. To access addiction treatment in Tennessee, contact our helpful admissions staff today.