Opioid Prescriptions Outnumber People in These Counties

For over 25 years, opioid addiction has raged throughout the United States, transcending boundaries of race, income, and age to bring harm to Americans in both small towns and bustling cities throughout the country. The opioid epidemic has brought profound despair to individuals, communities, and society as a whole, and been responsible for hundreds of thousands of deaths – causing an unprecedented decline in U.S. life expectancy and an economic burden of over $1 trillion a year. (These are the fastest-growing causes of death in America.)

The epidemic is the result of a massive failure at nearly every level of the U.S. healthcare system, from Big Pharma’s deceptive marketing of opioids to clinicians overprescribing them through both irresponsible overtreatment and blatant fraud. 

While the opioid epidemic has affected all Americans, it has disproportionately impacted poor rural communities, where opioid prescription rates and ultimately drug  overdose deaths are highest.

To determine the places where the most opioids are prescribed, 24/7 Tempo reviewed data on opioid dispensation from the Centers for Disease Control and Prevention. Counties and county equivalents (independent cities in Virginia) were ranked based on the opioid prescriptions dispensed per capita in 2020. Prescriptions are based on the location of the prescriber rather than the location of the pharmacy. Data on average annual drug overdoses per capita came from the CDC and is for the years 2018 through 2021. Supplemental data on median household income and population is from the U.S. Census Bureau’s 2021 American Community Survey and reflects five-year estimates.

In 2020, there were more opioid prescriptions dispensed than there were people in 112 counties. In the place with the highest opioid dispensation rate – Norton, Virginia – more than four opioid prescriptions were dispensed for every resident. The places with the highest opioid prescription rates tend to be impoverished rural communities in the South, where access to quality healthcare treatment is lower and the prevalence of chronic pain higher. In 45 of the 50 counties with the highest opioid dispensation rate (2020)s, the poverty rate is higher than the 12.6% national figure. (Here’s a list of the counties with the worst drug problem in every state.)

Higher opioid prescription rates are also directly linked to higher rates of opioid abuse. According to one study published in the peer-reviewed American Journal of Psychiatry in April 2022, for every county-level increase in the opioid dispensation rate (in 2020) of 35 prescriptions per 100 residents, the odds of an individual in that county being addicted to prescription opioids increases by 10%.

As prescription opioids become less effective or more difficult to obtain over time, patients may seek out heroin or fentanyl in illicit drug markets, vastly increasing their drug dependence and risk of overdose. And with roughly 80% new heroin users reporting pills as their initiation to opioid use, residents in counties with more opioid prescriptions per capita may be at a greater risk of overdose than in other parts of the country.