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The Rural Sociological Society (RSS) has honored two faculty members from Iowa State’s Department of Sociology and Criminal Justice with the 2021 Fred Buttel Outstanding Scholarly Achievement Award.

David Peters, professor of sociology and ISU Extension rural sociologist, and Andrew Hochstetler, professor of criminal justice, received the award for their study, “The Opioid Hydra: Understanding Overdose Mortality Epidemics and Syndemics Across the Rural-Urban Continuum.” The study’s additional authors are Shannon Monnat, Syracuse University, and Mark Berg, University of Iowa. The journal Rural Sociology published the team’s research in October 2019.

Excellence honored

The award recognizes outstanding scholarship in the form of either a book or article that demonstrates excellence in scholarly work in the same spirit exemplified by Fred Buttel, a celebrated professor of rural sociology and environmental studies at the University of Wisconsin-Madison, who passed away in 2005.

“The Buttel Award is one of the highest research honors in rural sociology, a tangible expression of the quality of our scholarship from our colleagues,” Peters said. “I find it heartening that interdisciplinary work was also recognized, as our team included scholars from criminology and public health.”

Seeking to understand the opioid crisis

Fatal opioid overdoses have ballooned in the United States over the past two decades, creating a major public health crisis in both rural and urban communities. According to the Centers for Disease Control, two-thirds of all overdose deaths involve opioids, claiming 47,600 lives in 2017 alone, and nearly 360,000 since 1999.

Using data from 2002 through 2016, Peters and Hochstetler found that the opioid crisis has transitioned from primarily prescription drugs and heroin to synthetic opioids and multiple-opioid mixtures. They also discovered that there are now multiple, overlapping epidemics—called a syndemic—not just a single opioid overdose epidemic.

Data shows opioid crisis knows no boundaries

Their research indicates that counties across the United States that are battling prescription-related overdoses—both rural and urban—are less populated; more remote; comprise older, mostly white individuals; have a history of drug abuse; and are former farm and factory communities that have been in a constant state of decline since the 1990s. Conversely, they discovered that counties experiencing a heroin and opioid syndemic tend to be urban, connected to interstates, ethnically diverse and more economically secure.

“In a sense, the crisis is like the multiple-headed Hydra of ancient Greek mythology, involving heroin, prescription and synthetic opioids,” the researchers write in the study. “As communities sever one head of the opioid problem, a new drug appears to take its place.”

The team’s study summarizes three key findings. First, the opioid crisis is no longer a prescription-drug or heroin crisis. Instead, it has transitioned to synthetic opioids and multiple-opioid mixtures. Second, there is not a single opioid epidemic, but rather multiple, overlapping epidemics, with the prescription opioid epidemic currently prevailing. Finally, a small share of counties are experiencing three simultaneous epidemics of prescriptions, heroin and synthetics.

Peters and Hochstetler’s conclusion is that multiple intervention strategies are necessary to address the escalating opioid syndemic, including expanded drug addiction and treatment services; stricter regulations surrounding opioid prescribing and dispensing practices; and greater efforts to prevent illicit opioids from entering the United States.

“Our research shows that the opioid problem is now dominated by synthetic opioid analogs, and that the crisis has spread across the nation. Our research has also demonstrated to policymakers that better regulation of prescription opioids will not abate the overdoses, as this is only a small share of overdoses nationally,” Peters said. “Combatting the opioid epidemic means shifting from prescription-focused policies to ones that target drug trafficking organizations to limit supply and to focus on youth substance abuse prevention programs to limit demand from future drug users.”

Hochstetler added that their research has allowed them to visit some of the counties experiencing significant opioid overdoses and to talk with local officials about how they are combatting the problem locally.

“As part of a related project, we’ve been able to provide some guidance and small start-up funds for the development of opioid intelligence initiatives by local law enforcement,” Hochstetler said.