Rural areas across the nation, hit hardest by the opioid crisis, have been struggling to acquire their fair share of settlement funds to fight the opioid epidemic. Tim Buck is the community manager of Pamlico County, a tight-knit rural community in North Carolina, that also happens to have the highest rate of opioid overdose deaths in the state. He reported, “Most folks know these individuals or know somebody who knows them…We all feel it and we hate it when our folks hurt.”

Now that settlement funds from opioid manufacturers and distributors have been accumulating, it would make sense that Pamlico County would be among the counties to receive the highest portion of the funds. Yet, formulas that have been devised to distribute funds often place a high level of importance on population. This means rural areas like Pamlico County will see a pitiful sum compared to that of more densely populated counties.

For example, out of one multibillion-dollar national settlement, Pamlico County will receive $773,000, whereas the more densely populated Wake County (home to state’s capital Raleigh) will receive $36 million. This is although Wake County ranked 87th, well below Pamlico (1st), in its opioid overdose death rate for the decade.

Photo by Mark Stebnicki from Pexels

And there is a reason why these rural communities suffer from a higher death rate. In the 1990s, opioid companies used misleading marketing techniques to help increase prescription rates. They specifically targeted lumber, coal, and manufacturing towns across Appalachia. And as opioids entered these communities at a rapid pace, some residents became addicted. With time, these residents turned to heroin and fentanyl, and the epidemic began to enter the suburbs and cities.

The story is much the same across the nation, and rural areas are beginning to fight back and demand more funding for their disproportionately affected populations. Robert Pack, co-director of East Tennessee State University’s Addiction Science Center, said, with proper funding, “you could really diminish what is effectively generational, more than 20 years of harm in rural areas.”

Even entire states are fighting back, claiming their population should not be a determinate factor in the funding they receive. West Virginia Attorney General Patrick Morrisey has refused national opioid settlements on multiple occasions because of their distribution methods, preferring to pursue separate lawsuits instead.

Pennsylvania has led the way with its own formula to distribute funds across its 67 counties. The formula considers the number of opioid-related hospitalizations as well as the number of instances where first responders utilized an overdose reversal medication known as naloxone. The 11 counties left without the funds needed to make an impact then received a minimum of $1 million of the $1.07 billion in settlement funds.

If other parts of the country were to follow in Pennsylvania’s path, local officials could begin to implement more significant initiatives. Until then, Nidhi Sachdeva, leader of opioid and health initiatives for the North Carolina Association of County Commissioners, recommends that rural counties look toward lower-cost, evidence-based options. This could range from distributing naloxone to connecting people to housing.

Some counties have also turned to pooling resources, as Martin, Tyrell, and Washington County in eastern North Carolina have done. With the funds, they plan to establish a regional health department.

Lori Laske, a commissioner of a county in Colorado facing the same funding dilemma, said, “Nobody has paid any attention to our rural areas and this problem for years…[The money] is never enough, but it’s more than we had, and it’s a start.”

Sources:

Rural communities are often short-changed when it comes to opioid settlement funds

Conceptualizing and Measuring Abatement from the Opioid Epidemic: A Case Study from Pennsylvania

How America Got Hooked On A Deadly Drug