John Kirby points approvingly to a worn but cheery mural, its “Recovery is everywhere!” message plastered across a red barn. He is weaving his way across a field of puddles, heading towards a group of goats and chickens before meeting with his mother, a resident here at the Dawn Farm addiction treatment center. Kirby, a white, 23-year-old mechanic from middle-class suburbia, recognizes that he and his family do not match the stereotypical drug-user profile. “I always thought that people who used drugs lived under bridges in big cities,” Kirby says. “Well, my mother was a functioning drug addict. She raised a family and held a job and all the while she was doing painkillers. It was sort of an unspoken problem.” Each year since 2012, opioid overdoses have killed more people than car accidents in Kirby’s home of Washtenaw County, Michigan. Over half of these deaths, the county’s health department reports, are caused by prescription medications.
Unlike other drug crises, which are often rooted in urban centers, the opioid epidemic has found its hotbed in rural and suburban white America, with the Centers for Disease Control and Prevention (CDC) reporting that 90% of opioid abusers are non-Hispanic whites, and the majority are rural or suburban. The American Society of Addiction Medicine estimates that 46 Americans die each day from prescription opioid overdoses, equating to nearly 17,000 deaths annually, and from 2002 to 2013, the Society reports that rates of death from opioid overdose nearly quadrupled in the United States. Methadone, OxyContin, and Vicodin are the drugs most commonly used by the more than two million Americans who abuse prescription opioids, according to the CDC.
The Washtenaw Health Initiative Opioid Project provides one response to this sharp uptick in opioid overdoses in Washtenaw County. The Opioid Project seeks to improve upon the drug abuse-law enforcement cycle by bringing together over 40 community members from hospitals, public health departments, law enforcement, treatment facilities, community groups, and those in recovery. The group follows the Project Lazarus model, a method pioneered in the North Carolina mountains which asserts that communities are responsible for their own health and that every drug overdose is preventable. With these guiding principles, the Opioid Project is divided into working groups focused on topics such as community education, hospital emergency department policies, and patient pain support. Since its inception in 2013, the Opioid Project has seen success in bolstering recovery programs, advocating for policy change, and hosting community forums. As Opioid Project staffer Angy Perez Martinez says, however, “The larger trend in the country is that opioid deaths are going up, up, up. It’s hard to fight that trend. Even stabilizing the numbers would put us way above other communities without coalitions.”
The Opioid Project’s first hurdle was confronting lack of community awareness about the opioid epidemic. Carrie Rheingans, Washtenaw Health Initiative Project Manager, believes white, rural, close-knit communities like those in Washtenaw County often employ a “shove it under the rug” strategy to avoid discussion of sensitive topics that make their communities look bad. “I would say there’s pockets of awareness [about opioid abuse], but I would say more educated, more affluent folks only hear about it, you know, on NPR, or over dinner with a glass of wine,” she says. “It’s maybe theoretical for them, even though we know now that opioids affect people of all ages and social classes.”
The Opioid Project benefits from a powerful community resource: Dawn Farm, an innovative residential treatment program in Ypsilanti, Michigan. Founded in 1973 primarily as a residential program for alcohol addiction, Dawn Farm has gotten creative in response to the spike in prescription opioid addiction in the past decade. It admits anyone, regardless of ability to pay, and focuses on holistic, community-based recovery. Residents work communally on the farm in addition to participating in more traditional treatment activities.
Washtenaw County is not alone. With such startling spikes in abuse rates, small towns across the country are no longer claiming that drugs are cities’ problems. In 2014, the American Society of Addiction Medicine reports, 34 states hosted prescription drug abuse task force programs, up from 29 states in 2012. Rheingans believes that these programs have potential, noting that funding, a spirit of collaboration, and good relationships with schools and law enforcement are critical to a task force’s success. Additionally, she argues that access to data is an important first step. “If you’re going to address a problem, you have to define the problem. And it’s hard for them to even define the problem,” Rheingans says. “It’s hard for us, and we’re a community that has really good access to data.”
Mary Martin, one such data-collector and an opioid researcher at Miami University in Oxford, Ohio, runs out of fingers when ticking off the issues those seeking treatment face: wait lists are long, drug use is criminalized, treatment is expensive, physicians are at capacity and the stigma surrounding drug use is pervasive. She believes that the rise in white, rural opioid usage – in Washtenaw County, in her research region of Ohioan Appalachia, and around the country – is due primarily to the bleak economic situations in many of these isolated communities. Nathan Kraatz of the Drug Free Action Alliance echoes Martin’s sentiments on stigma. “Communities can support those who are addicted to a drug the same way they support other people who are sick,” Kraatz says. “If we treat addiction like the disease that it is and focus on public health strategies to prevent and treat it, we can build a system that can manage addiction just like we manage other diseases.”
In 2016, the number of overdoses in Washtenaw County dropped by 25%, and dozens of recovering addicts completed the Dawn Farm residential program. Rheingans is cautiously optimistic about the Opioid Project’s progress but remains adamant: “We believe 49 deaths [in 2016] is 49 too many. There’s a lot of work still to do.”