The Opioid Hydra: Understanding Mortality Epidemics and Syndemics Across the Rural-Urban Continuum.

摘要: Deaths from opioid use disorders (OUDs) have become a major issue in the United States, increasing at a faster pace in micropolitan (778 percent) and non-core (723 percent) areas than in metropolitan ones (387 percent) since 1999. Our analysis identifies OUD mortality epidemics by opioid drug type at the county-level using latent profile analysis. We then run multinomial logistic regressions to model membership in OUD epidemic classes using socioeconomic correlates, disaggregated by metropolitan and non-metropolitan areas. We identify three distinct epidemics (prescription opioids, heroin, and prescription-synthetic mixes) and one syndemic involving all opioids. The opioid crisis took root in communities with a long history of opioid drug abuse. Over-prescribing increased prescription vulnerability in metropolitans, but in rural places it increased multiple-opioid risk. Work disability placed rural areas at …