After nearly a decade when US drug overdose death rates were higher in rural parts of the country, drug death rates have shifted to be higher in urban areas, according to a new analysis from the US Centers for Disease Control and Prevention's National Center for Health Statistics.
Researchers found that from 1999 through 2003, drug overdose death rates were higher in urban counties than in rural counties. Then, from 2004 through 2006, overdose mortality rates in rural and urban counties were similar. In 2007 through 2015, overdose mortality rates were higher in rural counties than in urban counties. But in 2016 and 2017, urban counties once again had higher rates of drug overdose fatalities.
While urban counties had higher rates of overdose deaths involving heroin, cocaine and synthetic opioids such as fentanyl in 2017, rural counties had higher rates of overdose deaths involving prescription opioids such as morphine, codeine, hydrocodone and oxycodone.
The overdose death rate related to stimulants such as methamphetamine and amphetamines was 4 per 100,000 in rural counties, higher than the rate of 3.1 per 100,000 in urban counties.
In 2017, There were 5.2 heroin-related overdose deaths for every 100,000 people in urban counties, whereas rural counties had a rate of 2.9 heroin-related fatalities for every 100,000 people.
In urban counties, the rate of overdose deaths from synthetic opioids such as fentanyl, fentanyl analogs and tramadol was 9.3 per 100,000; and in rural counties that rate was 7 per 100,000. Death rates involving cocaine were also higher in urban counties, with a rate of 4.6 per 100,000, compared to 2.4 per 100,000 in rural counties.
But, Dr. Caleb Alexander, co-director of the Center for Drug Safety and Effectiveness at Johns Hopkins, said it was important to not make too much of the distinction between rural and urban areas. "It's important not to lose the forest from the trees here," he wrote in an email to CNN. "Overall the trends and rates are much more similar than they are different between these communities."
Alexander noted that the increased overdose rate in urban areas "is attributable to the greater use of heroin and illicit fentanyl in these settings."
"The data demonstrate continued increases in mortality through 2017, and they underscore that the epidemic has had a profound impact in rural and urban areas alike," he added.
Drug overdose deaths in the United States declined 5.1% in 2018, according to preliminary data released in July by the US Centers for Disease Control and Prevention's National Center for Health Statistics. Researchers estimate there were 68,557 drug overdose deaths in 2018, and 47,590 involved opioids.