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America’s Crushing Opioids Big Problems for Small Towns  

This is Lake Worth, Florida, a short bridge across the Intercoastal Waterway but a world apart from glistening Palm Beach. The old town center is a study in compact eclecticism: brightly painted murals dance from historic art deco walls, fresh civil rights tributes punctuate public areas, and there’s an edgy, accomplished art scene. Landmark buildings and fair-trade shops share real estate with laundromats and check-cashing counters. The many barkeepers are busy; on a Monday morning their stools are full. Lake Worth’s median income is $36,000 and while purchasing power is modest, street life is vibrant. It’s where 24-year-old Nick is eight months into recovery from an opioid addiction he’s had since age fifteen. Family? They cut him off long ago, and he’s been on his own. Last year, someone spotted him splayed behind a dumpster. The next thing Nick knew, he was in rehab, among thousands of local addicts in and out of Lake Worth’s several hundred sober homes and halfway houses.  

Nick found a low-cost beachside haven for people fighting drug dependence, but this small town of 38,000 is also a big draw for active users seeking cheap and ready opioid knockoffs. The combined population of recovering and current addicts simply accelerates the relapse rate, of course. The main culprit is the illegal synthetic Fentanyl and its deadly consequences. Opioids’ low-cost imitator cuts into life expectancy and threatens a burgeoning population largely ignorant of the danger: patients on painkillers. Lake Worth’s is a story told all over the United States, where each day, including this one, upward of 150 people die from opioid overdose. That’s over fifty thousand a year.  

Hardest hit are small towns and rural areas, where doctors, clinics, and hospitals, if there are any, are ill equipped for the epidemic. With emergency responders overwhelmed by the sheer volume of overdose calls, mayors are screaming for federal help. Right here, Lake Worth’s police department devotes half of its staff time to drugs: the trade, the addiction, the overdose.   

Nick has stepped outside from his apprentice work at Solid Image Tattoo and Piercing for a sidewalk smoke with ink artist John Dudek. Asked how he’s doing, he shoots Dudek a glance and they both break into a short, uneasy laugh. “I’m alive,” Nick says. Dudek shakes his head and echoes a common refrain: doctors and drug companies have developed a Percocet response to pain, when Tylenol, heat and ice were once plenty good enough. Publicly, the medical establishment has strongly pushed back on usage. This time last year, top researchers dismissed the opioid solution to Americans’ most common ailments—knee, hip, and back distress—as no more effective than the “old school” therapies that Dudek recalls. The Center for Disease Control created guidelines for prescription opioids designed to protect several vulnerable groups, but as it acknowledged, it left out big portions of the population, including the broad under-18 category that Nick fell into when he started using at age 15. Despite American physicians’ dramatic reduction in prescriptions—a 22 percent drop from 2013 to 2017—addiction is still gaining ground. A disturbing study from the Annals of Internal Medicine puts it bluntly: even when armed with information about a patient’s prior abuse, physicians still prescribe the meds. A stunning 91 percent of people who previously overdosed on opioids continue to receive more painkillers; 70 percent of them continue to get opioid scripts from the very physician who previously treated that patient for the overdose.  

Unchecked, the numbers of new addicts will explode. Americans are living longer—US Dept. of Health and Human Services tells us that 60-year old Americans today have a better than fifty percent chance of living into their nineties—and their significant pain will increase. But while medical groups and the U.S. Surgeon General recommend physicians choose other chronic pain treatment and the lowest dose possible when they prescribe an opioid, doctors’ practices are quite different. Lawmakers and drug manufacturers and will continue that battle, but the toughest challenge is on the street where the steady supply of fentanyl from China and Mexico is unstoppable. Fentanyl’s damage is particularly brutal among low-income minorities because the synthetic is fast, easy, and affordable. Users and fatalities are soaring among African Americans, and other minorities. Decimated by widespread Fentanyl abuse, the Cherokee Nation was the first group to file suit against opioid drug manufacturers. Palm Beach County, which includes the town of Lake Worth, has also gone to court against drug companies.   

Quick to grasp the opioid demographics and the downward spiral, Florida devised a way to reach addicts, regardless of their income. Marshalling data, knowhow and resources, state leaders galvanized lawmakers, courts, and the Florida Department of Children and Families to provide medication-assisted treatment combined with behavioral health counseling. They well know their efforts cannot keep pace with fentanyl, but they want to prevent an addict like Nick from relapsing and extend him help if he does.


Concerned about the growing human and financial tolls on your community? Examine the financial breakdown from the National Institute on Drug Abuse. Looking for a way to make a practical difference? The US Department of Health and Human Services offers solutions for affinity and faith-based groups seeking engagement. Are you worried about your own or another’s consumption of pain meds? The NIH HEAL initiative outlines concrete steps to recovery and rehabilitation. Are you a health-care professional? See the CDC’s Guide to Opioid Patient Communication for more focused information.