Many people associate the prescription opioid epidemic with rural America, where “hillbilly heroin,” as OxyContin is sometimes called, has claimed many lives. But new research shows that opioid misuse and addiction are now as prevalent in urban areas and suburbs as they are in rural ones.

A team of researchers at the U.S. Department of Health and Human Services analyzed nationally representative survey data to determine how prescription opioids are used and misused in large metropolitan areas (with a population of greater than 1 million), small metropolitan areas (50,000 to 1 million) and non-metropolitan areas. The study found that the proportion of the population using prescribed opioids in the past 12 months was sizable and of similar magnitude across large metropolitan areas (36.0 percent), small metropolitan areas (40.1 percent) and non-metropolitan areas (39.9 percent).

Source: Study by Beth Han and colleagues in Annals of Internal Medicine

The investigators then dug into the data on those individuals who had used prescription opioids. They determined how many survey participants misused prescription opioids but had not (at least not yet) developed a serious enough problem to warrant a medical diagnosis of opioid user disorder, as well as how many were misusing opioids and experiencing sufficient harm and signs of addiction to meet such diagnostic criteria.  Opioid misuse without a diagnosis of disorder was not concentrated in rural areas. In fact the rate was, if anything, slightly higher (11.3 percent) in big cities than in nonmetropolitan areas (9.0 percent). The prevalence of opioid use disorder also varied little across geographic areas.

These findings don’t erase the fact that rural areas face unique challenges regarding prescription opioids. Outside urban areas, health-care professionals who can treat addicted patients are in short supply and first responders to overdose emergencies, when every second counts, often have significant distances to travel.  That said, it is no longer appropriate to describe prescription opioid addiction as a rural phenomenon, because it has spread throughout cities, suburbs and towns. What was once a rural epidemic is now a national one.

Respondents who took part in The Washington Post-Kaiser Family Foundation survey on long-term, opioid painkiller use share their experiences of living with pain (Monica Akhtar, Erin Patrick O'Connor/The Washington Post)