220 is the Magic Number

By: Marcus J. Hopkins, Blogger

Earlier this month, The Wall Street Journal reported that the CDC has listen 220 counties in the United States as being at high risk of an HIV and/or Hepatitis C outbreak, largely related to opioid Injection Drug Use/Users (IDUs). Out of over 3,100 counties in the U.S., these 220 counties – including Scott Co., Indiana, home of one of the highest profile mass HIV/HCV outbreaks in recent U.S. history – share specific factors that seem to be related to a high rate of new HIV/HCV infections, such as high unemployment rates, overdose deaths, and sales of prescription opioid painkillers.

For those of us who have been covering opioid prescription and heroin abuse issues, none of this is news. These factors have long been contributing factors to opioid and heroin abuse, but because of the remote nature of many of these counties, little attention was ever paid and little due diligence was ever done in the way of addressing their needs. These areas, while rich in natural beauty and great for those who prefer life away from the so-called “Big Cities,” are also home to some of the highest levels of endemic poverty in the U.S. Economic development in these areas has been hampered by a number of issues – lack of qualified workers, resistance or reluctance to modernization (many of these counties still lack adequate high-speed Internet access), the remote nature of the areas in relation to centers of commerce, and a regional distaste for “outsiders” – all of which leaves residents with few, if any, good options for work. Residents are lucky to find full-time employment at all, and many are forced to subsist off of part-time and contract work, the opportunities for which are few and far between.

With endemic unemployment and poverty rates high, the sad fact is that sheer boredom comes into play as a factor for drug abuse. Many of my high school friends who ended up addicted to prescription opioid drugs started not because they suffered from high levels or long-lasting chronic pain, but because they were bored, and there was nothing else to do, except for snort some pills; once those pills were made “abuse proof,” they learned how to cook them down, filter out the plastic coating with a piece of mesh, and inject them directly into their bloodstreams. Once needles come into play, what was once a way to survive the boredom turns into a full-blown addiction, anecdotally harder to kick than any other.

Map of the United States showing counties at risk for HIV and HCV outbreaks

Photo Source: Wall Street Journal

Of the 220 suspect counties shown on the WSJ’s map, the vast majority cover Kentucky, Tennessee, and West Virginia, three states as well known for their contribution to the entertainment industry’s portrayal of poverty as they are for hillbilly jokes. The jovial Appalachians from the Beverly Hillbillies still serve as a point of reference for outsiders, but that well-meaning-yet-easily-conned stereotype bears little resemblance to real life Appalachians, where striking oil would be the best thing to ever happen, but residents are far likelier to tap a vein for injection, rather than natural resources.

Compounding the problem is the reality that the remote nature of these counties makes increasing access to adequate healthcare and treatment services both difficult and costly. While telemedicine is quickly becoming a valuable resource, those resources are already stretched to capacity, with few applicants lining up for jobs and limited financial means to pay for additional staff. All three of the aforementioned states are currently facing massively budget shortfalls for a variety reasons, one of which includes the flight of higher-income citizens to states with better job prospects, leaving them to rely upon an increasingly impoverished tax base, which bodes poorly for advocates of additional funding.

Confronting this high-risk label is going to be a unique challenge for the counties in question, and there are no easy answers or quick fixes. This is going to be a multi-year, if not multi-decade, fight to expand educational, employment, and economic opportunities to these areas that will help address generations of poverty and joblessness. Those efforts must be accompanied by concurrent healthcare efforts, without which I fear that we will continue to see high levels of opioid abuse and equally high levels of accompanying HIV and HCV infections.

Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.



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