Premature deaths, overdoses bigger problem in rural US

Drugs are prepared to shoot intravenously by a user addicted to heroin in St. Johnsbury Vermont. (File photo).
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Drugs are prepared to shoot intravenously by a user addicted to heroin in St. Johnsbury Vermont. (File photo).

A country home might be a less healthy home, a lot less healthy.

Almost 1 in 5 rural counties in the U.S. saw increases in the number of premature deaths over the past decade — even as most large urban counties saw regular improvements in their premature death rates, according to new rankings released Wednesday.

"That was surprising and shocking to me," said Bridget Catlin, director of the County Health Rankings, a collaboration of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

Catlin noted that 1 in 6 Americans live in a rural county, which as a rule have higher rates of smoking, obesity, child poverty and teen births than large urban counties. Rural counties are defined as those with less than 50,000 people. Forty-six million people live in 1,974 rural counties.

The spike in premature deaths in many rural counties was fueled in part by an epidemic in drug overdose deaths occurring throughout the United States, noted the 2016 County Health Rankings report, which compares health differences on a wide range of measures on a county-by-county basis.

There has been a 79 percent increase in the rate of fatal overdoses since 2002, and a 200 percent hike in the rate of death involving opioids, which include heroin and prescription painkiller pills.

"Drug overdose deaths appear highest in northern Appalachia and in parts of the West/Southwest," said the report, Such deaths were "lowest in the Northeast and higher in rural counties than in other types of counties."

"This is a problem that is hitting a lot of places, and a lot of people from all walks of life," said Catlin.

Nationally, the average rate of drug overdose deaths is 13 per 100,000 people.

But 16 percent of counties have drug overdose rates that are above 20 people per every 100,000 — "with some counties having rates as high as 85 per 100,000," the report said.

Drug overdoses are "all around us," said Julie Miller, administrator of the health department in rural Boone County, West Virginia, where the report identified the overdose death rate at more than 81 per every 100,000 people.

Miller said Boone County's drug problem has become more severe in the past five years.

"A couple of years ago, people were surprised" to hear of a fatal overdose, she said. Now, "it's not out of the ordinary," Miller said.

The county has seen a huge increase in the number of cases of hepatitis C and hepatitis B, which are often transmitted through sharing of syringes or bodily fluids.

In 2010, Boone County had 24 cases of hepatitis C and just two cases of hepatitis B. This year, Miller said, there are 54 reported cases of hepatitis C and 24 cases of hep B.

Drug use isn't the only health problem in Boone County.

"Everybody has bad health," Miller said. "They're overweight, they don't exercise, they eat bad food."

"We have a lot of a diabetes, a lot of people with lung disease," she said. "You've got people that eat like their grandparents or their parents ate, but biscuits and gravy for them when they work and have manual labor jobs is a lot different from biscuits and gravy for me."

Miller also said there are not many sidewalks around Boone County, which discourages efforts at exercising.

Catlin of County Health Rankings said Boone County's experience is a common one for many rural counties, and explains why their premature death rates have spiked in some such counties, countering a nationwide trend.

"You really can't pinpoint any single factor," Catlin said. But "rural counties struggle with lack of access to jobs, to health care, to physical activity."

"There isn't always a safe place to exercise."

Catlin said it's possible that fatal drug overdoses might be more prevalent in rural counties "because of a lack of medication than can prevent overdoses."

That medication, naloxone hydrochloride, can reverse the effects of opiods.

Naloxone is not universally available from pharmacies nationwide without a prescription. West Virginia's legislature passed a bill in its recently concluded session that would allow pharmacists to dispense naloxone without a prescription.

"When somebody overdoses there isn't always time to get them to a hospital," Catlin said. "That's why it's so important than first responders carry [naloxone] with them, and use it if necessary. We need to get it in the hands of a lot more people."

Last November, the U.S. Food and Drug Administration approved Narcan Nasal Spray, the first nasal spray version of naloxone, which is made by Adapt Pharma.

In January, Adapt Pharma said it will offer a free carton of Narcan Nasal Spray to all U.S. high schools through state education departments, and work with the Clinton Health Matters Initiative to increase naloxone access nationwide.

In addition to the schools initiative, Adapt Pharma is also partnering with other organizations like the National Association of School Nurses to provide free nasal spray to first responders, caregivers and local and state authorities.