Addiction by Design: Place, Isolation, and Deaths of Despair

By on October 31, 2018

From Brookings:  Deviating from its more typical “best of (neighborhoods, doctors, crab shacks…)” lifestyle articles, Baltimore Magazine featured in its July issue a far less sunny piece on the ravaging impacts of Hagerstown, Md.’s opioid crisis. Can H-Town Kick Its Habit?, by Ron Cassie and Lauren Larocca, describes what’s become an all too familiar story of how a once thriving rural community lost its economic base—in this case, manufacturing—and, over time, the businesses and jobs it directly and indirectly supported. Growth stalled, buildings were shuttered, and the cross section of highways that once carried resources and products in and out of town today enable the convenient trafficking of heroin, fentanyl, and other drugs. The death toll has since been climbing precipitously.

The perilous connections between economic decay, deepening despair, and the shocking rise in related overdoses and suicides—in Hagerstown and around the country—have been well-documented. As Elizabeth Kneebone and Scott Allard demonstrate in a 2017 report, almost every county in the United States experienced an uptick in drug overdose deaths between 2000 and 2015; none registered a decline. Moreover, it is largely poor counties—and counties that became poorer between 2000 and 2015—that have been among the hardest hit. New U.S. Department of Health Human Services research confirms that, on average, areas with lower economic prospects have higher rates of opioid prescriptions, hospitalizations, and overdose deaths.

With over a quarter of the population living below the poverty line, and an unemployment rate over 10 percent, Hagerstown fits the profile of a community where joblessness and poverty have a strong correlation to—and likely a causal effect on—drug use, and its destructive individual and communal effects. But as the authors of H-town astutely observe, Hagerstown’s economic challenges have a physical manifestation that arguably has made its own—albeit less widely explored—contribution to the scourge. Perhaps it is not only the economic distress in Hagerstown and other similarly situated communities, but also the concomitant decline in the place itself—in its collection of Main Street businesses, gathering places, and the social connections they engender—that contributes to residents’ mental and emotional anguish.  It is this anguish that then leads too many to seek out the quick, if short-lived, reprieve that opioids and other such palliatives provide. 

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