This shift began happening in 2015 and, according to experts like Dr. Daniel Ciccarone, is due to a change in the dynamic of opioid addiction. The exact nature of this shift isn’t precisely known.
One argument is that the crisis initially began because prescription opioid painkillers were available to virtually anyone in the United States at the discretion of a doctor. This allowed opioid addiction to grip Midwestern and Appalachian areas in a way other drugs could not.
As awareness of opioids grew, prescription pills became harder to come by. This pushed people who were already hooked to look for heroin and fentanyl–drugs more easily found in urban areas where illicit markets are already in place.
An alternative theory is that the epidemic has simply expanded to the point where it’s started to affect black and Hispanic populations who tend to live in more urban areas.
“Early on, this was seen as an epidemic affecting whites more than other groups,” said Dr. Ciccarone. “Increasingly, deaths in urban areas are starting to look brown and black.”
In 2017, there were a reported 22 overdose deaths per 100,000 people in urban areas, officially surpassing the 20 deaths per 100,000 in rural areas by a narrow margin.
Overdoses continue to be an epidemic, killing about 68,000 Americans last year. According to data from the Centers for Disease Control (CDC), overdoses in urban areas are affecting mostly men and are caused mostly by fentanyl and heroin. However, overdoses are killing more women in rural areas. These rural deaths are mostly caused by meth and opioid painkillers.
This epidemic doesn’t discriminate, not only between race and geography, but wealth and fame as well. Most recently, Saoirse Kennedy Hill, the granddaughter of Robert F. Kennedy, was found dead of an overdose on Thursday at just 22 years old. Other prominent people who lost their lives to overdose include the actor Philip Seymour Hoffman, the legendary musician Prince, and rapper Mac Miller.