01993nam a22001577a 4500999001900000008004100019100003000060245011500090260002100205300003300226520142700259773002001686906001401706942000701720952010801727  c516248d516248210220b           ||||| |||| 00| 0 eng d  aPeters, D.J. et al924287  aThe opioid hydra: Understanding overdose mortality epidemics and syndemics across the rural‐urban continuum   aRural Sociology   a85(3), Sep, 2020: p.589-622   aThe rapid increase of fatal opioid overdoses over the past two decades is a major U.S. public health problem, especially in non‐metropolitan communities. The crisis has transitioned from pharmaceuticals to illicit synthetic opioids and street mixtures, especially in urban areas. Using latent profile analysis, we classify n = 3,079 counties into distinct classes using CDC fatal overdose rates for specific opioids in 2002–2004, 2008–2012, and 2014–2016. We identify three distinct epidemics (prescription opioids, heroin, and prescription‐synthetic opioid mixtures) and one syndemic involving all opioids. We find that prescription‐related epidemic counties, whether rural or urban, have been “left behind” the rest of the nation. These communities are less populated and more remote, older and mostly white, have a history of drug abuse, and are former farm and factory communities that have been in decline since the 1990s. Overdoses in these places exemplify the “deaths of despair” narrative. By contrast, heroin and opioid syndemic counties tend to be more urban, connected to interstates, ethnically diverse, and in general more economically secure. The urban opioid crisis follows the path of previous drug epidemics, affecting a disadvantaged subpopulation that has been left behind rather than the entire community. County data on opioid epidemic class membership are provided. - Reproduced   aRural Sociology  aEPIDEMICS  cAR  00102ddc40709390340aIIPAbIIPAd2021-02-20h85(3), Sep, 2020: p.589-622 pAR124344r2021-02-20yAR