This study explores why some locales are resilient and other are vulnerable with respect to the prescription opioid overdose crisis.
The authors of this study aim to understand why some high overdose places were resilient to the prescription opioid overdose crisis (better than predicted), while others were vulnerable (worse than predicted). High-overdose resilient and vulnerable places had disability-dispensing-overdose pathways, legacies of mining, and polysubstance drug abuse. Resilient places were larger population micropolitans with extensive health and social services, norms of redemption and acceptance of addiction, and community-wide mobilization of public and non-profit resources. Vulnerable places were smaller, more remote, lacked services, and stigmatized addiction. First, the authors predicted prescription opioid overdose mortality in 2016–18 for N = 2,013 non-metropolitan counties using multivariable regression accounting. Second, the authors constructed a resiliency-vulnerability typology using observed, predicted, and residual values from the regression. Third, the authors selected a high-overdose resilient and vulnerable community for case study analysis using interviews, focus groups, and observations. (Published Abstract Provided)