Editors' Notebook

The impetus for DTN's seven-part series on the opioid crisis in rural America wasn't about taking a stand for or against painkillers, though by the commentary we received on the articles, some readers saw it that way.

In discussing the special issues of addiction in rural America -- the lack of alternatives, the lack of medical and psychological support for those suffering addiction -- we uncovered a growing issue: the debate over prescription medicines versus illegal forms of opioids such as heroin and fentanyl.

In no way was this series designed to have all of the answers. In fact, we realized early on the complexities of the issue made it critical to keep focus on the rural American story. It was an aspect of this problem that had largely gone unexplored, perhaps because of many of the same challenges we faced in telling the story.

We came into this series wanting to look at how prevalent opioid addiction was in rural America, and more specifically what may be fueling the problem.

Making this a story about prescription opioids versus synthetic opioids would miss the broader point.

Opioid painkillers can be effective tools to manage pain for people who need them. If managed correctly, opioids can improve quality of life for pain sufferers.

Drugs aren't the problem: Society's lack of management of how much drugs are prescribed, who takes them and for how long, is the issue.

As our series ran, we received Facebook comments from pro-opioid advocates. Some of them suggested prescription painkillers, such as hydrocodone or oxycodone, aren't really the class of opioids driving the current addiction crisis. Some went so far as to accuse DTN of using "fake" data -- though the numbers we cited on prescription overdose deaths came from the Centers for Disease Control and Prevention and other reputable sources.

We could talk endlessly about whether fentanyl or prescription opioid pills such as hydrocodone is driving the addiction crisis. However, here's what matters: Rural America is taking the brunt of the punches from an expanding opioid crisis. The rate of overdose deaths in rural America now outpaces urban America, and just 8% of all treatment centers reside in rural areas. (https://www.dtnpf.com/…)

That's alarming.

Also consider the occupational dangers farmers face on a nearly daily basis. Their livelihood is determined by staying healthy and as pain-free as possible. Many of them face the choice between not getting work done because of pain and taking what a doctor prescribes.

We know fentanyl is dangerous. We reported how deadly it could be, some of the steps being taken to stop illegal fentanyl coming from China, and legislation to help detect and treat quicker those who abuse the drug. (https://www.dtnpf.com/…)

Yet, just last weekend, there was a mass overdose involving fentanyl in Chico, California, leaving one dead and another 12 hospitalized -- all in one residence, with everyone between about 19 and 30 years old.

Aggressive efforts must be made to stop the illegal flow of the drug in the United States.

Yet, to fix the problem, everyone involved, from drug companies to politicians, from schoolteachers to local farmers, needs to admit it's a problem.

Prescription painkillers readily available in medicine cabinets in rural homes across the country pose the most immediate danger: 90% of teenagers with opioid addictions from painkillers obtained the drugs from friends or family.

One of the tragic stories we highlighted was from Jackson County, West Virginia, where 16 people ages 26 and younger were found dead from opioid overdose between 2006 and 2008. They all overdosed on prescription painkillers. (https://www.dtnpf.com/…)

Learning to secure those medicines provides the best opportunity for individual communities to make a difference on stemming addiction. We gave tips on what people can do to manage those drugs better. (https://www.dtnpf.com/…)

There are many powerful advocates who champion the virtues of opioids in managing pain. Opioids can be very effective, when they're used in the right manner. This, too, seems like a prime opportunity for those advocates to work to resolve the opioid issues that hit rural America.

Our interviews with rural families show they are concerned about the future of their communities.

While good federal and state policies are important on the treatment front, it is clear to us that the personal touch family, friends, co-workers and neighbors can give may be most critical in saving lives. (See https://www.dtnpf.com/…, and https://www.dtnpf.com/…)

When we began considering the project in spring 2018, we knew the only effective way to tell the story was to find farm families willing to openly share how addiction to opioids altered the course of their lives.

The stories were gut-wrenching, yet helped me keep perspective on what we were doing: to never forget the families that were victimized.

In many respects, rural America has been the ultimate victim in this ongoing national tragedy -- greatly in need and largely lacking help and resources. By one estimate, it would need an annual $60 billion investment for at least a decade in rural America to build out needed treatment infrastructure. (https://www.dtnpf.com/…) This is daunting, if not impossible, as the agricultural-based economy in rural areas continues to struggle.

That is the crux of the problem in rural America.

Further, the power of opioid addiction stigma is a major barrier to saving lives.

That's why it was critical for DTN to find personal stories in order to put a face to the crisis, perhaps to help communities begin to understand the nature of this problem and the real people who are hurt.

Families who shared their stories of struggle and triumph, recovery and loss, all had one thing in common -- they all battled loneliness and shame from stigma.

Their desire to change the future is beginning to override their fears, and they trusted us with their stories.

Some addicts rely on faith, networking with support groups, or they have strong family connections that ultimately lead to finding the right medical treatment. Others have not been as fortunate.

It can be treacherous for people to speak openly about addiction, whether it's about them or their loved ones.

It shouldn't be this way.

These people are your neighbors, rich and poor, athletes and farmers, grandmothers and uncles. It can happen to anyone.

Years ago, I was diagnosed with two bulging disks in my back. It caused debilitating sciatic pain in my legs.

I worked through months of fairly intense rehabilitation, and on many nights would not have slept without hydrocodone pills and muscle relaxers. Yet, I was fortunate: When the intense pain was finally gone, I had not developed a dependency on those powerful drugs.

It doesn't work that way for everyone.

Nearly everyone will deal with pain at some point. Our ultimate point was we need to do better in rural areas to make sure a painkiller doesn't become a killer.

Todd Neeley can be reached at todd.neeley@dtn.com

Follow him on Twitter @toddneeleyDTN

(GH/ES/AG)

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