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counties with the least economic distress (the lowest 25th percentile) and 20.2 in counties with the most (the highest 25th percentile). This difference of 7.9 deaths per 100,000 population is the equivalent of nearly 40,000 excess deaths over this 10-year period (Figure 2).2 The economic distress penalty remained even when controlling for a wide array of demographic and health care factors, including racial/ethnic and age composition, percent military veterans, metropolitan status, and designation as a primary-health or mentalhealth-professional shortage area. The U.S. drug overdose problem has reached epidemic levels, prompting President Trump to declare a public health emergency. Since 2000, 786,781 people in the United States have died from drug overdoses and other drug-related causes, with nearly 40 percent of those deaths occurring in the last three years alone. The news media regularly portrays the drug overdose epidemic as a national crisis, but some places have much higher drug mortality rates than others. On average, rates are higher in counties with higher levels of economic distress and family dissolution, and they are lower in counties with a larger per capita presence of religious establishments. These findings hold even when controlling for demographic differences, urban or rural status, and health care supply.

Drug Overdose Rates Are Highest in Places With the Most Economic and Family Distress