October 23, 2021

Opioid misuse is a public health crisis in the United States. Exploring potential underlying factors associated with large numbers of prescription opioid sales in communities across the country can help understand ways to prevent misuse. Research suggests that urbanization drives health behaviours. For example, sexually transmitted diseases are disproportionately more common in larger cities due to the large number of social connections in dense urban centers, which in turn increases the chances of contact between cases and susceptible individuals.

Research led by Pricila Mullachery, PhD, senior research scientist at the Drexel Urban Health Collaborative, identified links between population size and the distribution of opioid pills in the US. In the paper with co-author Usama Bilal, MD, PhD, MPH, the authors describe the distribution of opioid pill sales across 607 US commuting zones. Commuting zones are groups of counties that share interconnected economies.

This research found that mid-sized commuting zones had a disproportionate larger number of opioid pills sold between 2006 and 2014. This finding contrasts with previous reports about the opioid epidemic that place small towns in the epicenter of the epidemic. The authors emphasize that while it is true that a number of small towns in some parts of the country had an extremely high number of pills distributed, their results point to a larger pattern of opioid sales that may be related to population-level behaviors, the ability of local authorities to regulate prescribers and pharmacies, and the existence of illegal opioid markets. One potential mechanism for disproportionaly higher pill sales in mid-sized commuting zones is that patterns of commuting and exchanges in these areas have the potential to promote a larger number of contacts between users of opioids and healthcare settings, which leads to higher opioid pill sales. Meanwhile, these mid-sized commuting zones may not have the mechanisms in place to curb excessive distribution of these pills.

Understanding the dynamics of opioid pills sales and the potential role of population-level behaviors in the opioid epidemic may help create policies to prevent opioid misuse in different contexts across the rural-urban spectrum. To read the full article, click here.