Drugs have Devastated Rural Areas and One East TN Community is Turning That Around
America's drug epidemic has hit rural areas especially hard, but in the areas where treatment and community programs are needed most, economic distress and lack of access to healthcare exacerbate the problem.
The problem began surfacing in the late 1990s.
"It's unusual for a substance abuse problem to first surface in rural areas, but you had a work force that had a lot of injuries, coal miners in particular" said Roy Silver, a sociologist in Harlan County Kentucky. "People who may have legitimately needed some sort of pain relief were given this very powerful addictive substance and then sometimes their children would become addicted and from there it created a lot of stress and strain on the family and social fabric of our county."
Additionally, there was a nationwide shift in the way doctors manage pain. In 2001, The Joint Commission, which accredits nearly 21,000 healthcare organizations in America, named pain as a vital sign.
"You have those things, and then you have a high unemployment rate with a lot of idle time for people, and then you have an addictive substance that all came together in what you may call a perfect storm," Silver said.
Coal fuels the economy of Harlan County. It's the third largest county for coal production in Eastern Kentucky, yet in March, only 824 people worked for a coal mine in the county.
Harlan County has suffered from significant out-migration since the end of World War II. The population is now less than half of the size it was in 1940.
"It creates a sense of hopelessness and some people are looking to things to fulfill that sense of hopelessness or dull that sense of hopelessness," Silver said. "When you look at the pharmacological effects of prescription drug abuse, you understand that it dulls senses and it sort of makes people numb to some of the consequences of that. They're all part and parcel."
Though the economic decline in coal country contributed to the drug epidemic, other shared characteristics including poverty and lack of accessible treatment contributed to the same growth of the issue in other rural regions.
By 2016, overdose rates in rural areas surpassed that of urban centers, according to CDC data.
"There are no bus lines out here, there's no trolley. It's hard to get a cab," said Tom Garner.
A decade ago, Garner moved into a trailer park in rural Blount County. He now runs a non-profit out of a trailer where he once found a woman dead with a needle in her arm.
"Here, it's spaced out enough that you do have a sense of - I call it isolation. Some just prefer it as secrecy," Garner said. "You can hide in the darkness, you get caught up and nobody knows."
The woman Garner found in the trailer was clearly an overdose victim, but not every overdose is as easily identified.
The chief medical examiner for Knox County says rural overdoses are even more prevalent than the data shows.
In Knox County, a robust team of medical legal death investigators examines every suspected overdose death in the county.
The investigation begins at the scene of the death and includes researching background, medical records and the Controlled Substances Monitoring Database.
Some bodies then undergo full autopsy at the Regional Forensic Center.
"So obviously all of those we are going to do here are frequently missed more in the rural counties," medical examiner Dr. Darinka Mileusnic-Polchan said. "So there are definitely underreported numbers out there, there's no doubt about it."
Garner's trailer park non-profit, Harbours Gate, doesn't just help people will substance abuse issues. It also has small groups and classes for anger management and growing healthy relationships.
The non-profit also helps with job placement.
The point is to uncover the root causes of addiction and other unhealthy behavior.
"It takes community investment of time and effort. Yeah, you can go build a huge facility, but there's an infrastructure already here," Garner said. "You can build upon that existing, and it means so much more to people knowing they're a part of that."
Harbours Gate has many success stories, but Garner still attends too many funerals for his liking.
Garner's personalized and multidimensional approach to restoring rural communities fits the bill for how Harlan County sociologist Roy Silver says the problem can be solved.
"We have to look at the root causes and then prevent those root causes and prevent those from happening again," Silver said. "It's going to take a comprehensive effort both in terms of reigning in what happened with what the drug company's doing allowing this to go on, and also problems that surfaced in terms of high degrees of unemployment, rapid changes in the economy and things of that sort."
Silver says what his rural community lacks in resources and access to treatment it counteracted by the character of the people.
"The kinds of people, the quality of people, the willingness to help one another - those are assets that we have," Silver said. "A resiliency to deal with these problems with limited resources, that's also something that's noteworthy."