The 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.

中文翻译：

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阿片类九头蛇：了解整个城乡连续体的过量死亡率和流行病

在过去的二十年中，致命的阿片类药物过量的迅速增加是美国的主要公共卫生问题，尤其是在非大都市社区。这场危机已从制药业转变为非法的合成阿片类药物和街道混合物，特别是在城市地区。使用潜在特征分析，我们将n分类 = 2002-2004年，2008-2012年和2014-2016年使用特定阿片类药物的CDC致命过量使用率，将3,079个县划分为不同的类别。我们确定了三种不同的流行病（处方类阿片，海洛因和处方合成类阿片混合物）和一种涉及所有类阿片的流行病。我们发现与处方药有关的流行县，无论是农村还是城市，都已“落后”于全国其他地区。这些社区人口较少，偏远，较老，多数是白人，有吸毒史，是1990年代以来一直在减少的前农场和工厂社区。这些地方的药物过量代表了“绝望的死亡”的叙述。相比之下，海洛因和阿片类药物流行县往往更城市化，与州际相连，种族多样且总体上在经济上更安全。城市阿片类药物危机沿袭了先前的毒品流行之路，影响了一个被遗弃的弱势群体，而不是整个社区。提供了有关阿片类药物流行病类别成员资格的县级数据。