Ezell et al.: Why People in Rural Communities Use Opioids

In A Sociology of Empathy and Shared Understandings: Contextualizing Beliefs and Attitudes on Why People Use Opioids, authors Jerel M. Ezell (Center for Cultural Humility, Cornell), Brooke Olson (Biological Sciences, Cornell), Suzan M. Walters (Global Public Health, NYU), Samuel R. Friedman (Population Health, NYU Medicine), Lawrence Ouellet (Public Health, Illinois at Chicago), and Mai T. Pho (Chicago Medicine) examine drug use and people who use opioids or who inject drugs (PWUD) in rural areas, focusing on how specific forms of drug use have been normalized in some rural communities. Specifically, the authors assess how stakeholders explicate and relate to PWUD’s sociomedical identity and positionality.

According to the authors, there has been a steep rise in overdoses and mortality among PWUD globally, with some of the sharpest increases amassing in rural communities. In rural areas, the authors found there are two main pathways that lead to opioid use: (1) preponderance of physically straining jobs in rural areas whose duties promote injury, and (2) limited economic or employment advancement opportunities and limited recreational outlets.

The authors interviewed PWUD and stakeholders, including treatment professionals, in southern Illinois, which has some of the highest rates of opioid-related morbidity and mortality in the U.S. The questions for the PWUD sought to determine when the individual began using drugs, why they continued/relapsed, and what they perceived as the causes. Questions for the stakeholder participants aimed to capture perspectives on the kinds of social, economic, and situational factors that might contribute to the initiation and continuation of drug use and relapse patterns. The authors found four themes identified in the explanations: (1) sensation-seeking (sensory); (2) enhancing social and romantic relationships (relational); (3) recognizing, negotiating, and addressing physical pain (somatic); and (4) coping with difficult social circumstances or environmental factors (psychosocial).

At the same time, the authors found that many stakeholders lacked empathy in trying to understand the true reasonings behind PWUD usage and tended to emphasize perceived factors like lack of willpower and general deviance among PWUD. The authors propose that greater emphathy and more accurate understandings among caregivers and professional stakeholders could result in more PWUD receiving needed help and treatment.

The authors also go evaluate policies that generate shared understandings on the drug use etiology. These authors argue that these policies actually generate empathy and are well-positioned to improve outcomes for PWUD and improve this socially ostracized population’s relationships with professional stakeholders and the broader public.