If there is one thing that Americans can agree on at this moment in our history, it’s that we have an opioid problem. An epidemic that touches every state and county. In fact, we all likely know someone who has become addicted to oxycodone, morphine, fentanyl, or any of the other countless prescription painkillers that float around the American medical landscape. In 2016, over 37,000 Americans died of opioid overdoses. And we know small towns and rural communities with high rates of unemployment, like Pulaski, have been hit hardest by the crisis. But do our representatives in Congress know how bad the epidemic really is, and where?

That’s a question that a recent study out of Harvard’s School of Public Health set out to answer. The team of Drs. Lyndsey Rolheiser and S.V. Subramanian, along with Mr. Jack Cordes, used the CDC’s county-level opioid prescription rate data to construct estimates of the rates of opioid presence in each congressional district in 2016. The first-of-its-kind study illustrates the significant toll opioids have taken on Appalachia and the South, with districts in Alabama, Kentucky, Tennessee, and Mississippi all rising to the top with rates of 130-166 prescriptions per 100 people (4-5 prescriptions for every 3 citizens in those districts).

But the study jumped out to me because of the 8^th ranked district: Virginia’s 9^th. We have a rate of about 125 prescriptions per 100 people, or 5 for every 4 Virginians who call the 9^th home. These numbers speak volumes. The rate of maximum daily doses of painkillers prescribed correspond directly with overdoses and drug-related accidents in an area. In a saturated area, with more prescriptions than people, the addiction problems we see in our area begin to multiply. This all caught me off guard. I knew our corner of the state had a problem, but I had no idea how bad it was.

Part of this is because the data out there has masked our opioid crisis from both the nation and our little mountain community. In state rankings, Virginia consistently sits in the 30s, with a statewide prescribing average below the national average of 66 per 100. It almost looks like we’ve got this problem under control. But this low average comes from the very low saturation of opioids in the northern and eastern reaches of the Commonwealth. The 8^th district, which encompasses some 780,000 residents of Arlington, Alexandria, and parts of Fairfax County, ranks in the lowest 10 districts nationally, with a rate a quarter of ours (29.2 per 100). In fact, 6 of Virginia’s districts are below the national average. All but one have prescribing rates below 100 prescriptions per 100 people (1:1 ratios). Our commonwealth’s national rank hides the anomaly of the 9^th District.

Counting Counties (and Cities)

While the view from state rankings obscures our position in the opioid crisis, the CDC’s county rankings drown us in details. 2,962 counties report their annual prescribing data to the CDC (181 have none listed). And when they’re ranked from highest to lowest, 5 of Virginia’s independent cities rise to the top of the list, with the top 3 in Virginia’s 9^th: Norton (470.3 per 100), Martinsville (399.9 per 100), and Galax (394.4 per 100). That’s 4 opioid prescriptions per resident of Martinsville and Galax, and nearly 5 for every person in Norton! Half of the localities in the 9^th are in the top 10% of reporting counties, and 18 have rates over 100 prescriptions per 100 residents.

But this data also presents a few problems. After that immediate burst of Virginia counties and independent cities in the top 10%, the 25 from Virginia that make the list are spread thin. Pulaski County doesn’t make the top 200, even with a rate of 134.1 per 100 people. The bigger issue, though, is one of policy implementation. It’s easy to look at this list of counties and cities and say “It looks like you all have a problem.” To kick the handling of this epidemic to county and municipal governments, which we know are already stretched fiscally. Even on a state level, there are 12 Assembly Districts that span and spread out beyond the 9^th Congressional District. Henry and Montgomery Counties are split into 3 separate Assembly Districts. This can turn our opioid crisis into a big game of “Somebody Else’s Problem”.

And this is where the power of the Harvard team’s study lies. A congressional district is often the only unit that represents a continuous region of a state. Finding a problem as big as our opioid epidemic in a district can allow it to be brought to the federal level for aid. Whoever wins the 9^th House Seat this November has a duty to champion the health and welfare of our region that nobody else on the local, state, or national level is asked to shoulder. Knowing that we are in the top ten most opioid saturated districts ought to be a call to action for our legislator, as much as it should be for the rest of us in Southwest Virginia. In fact, our current representative, Mr. Morgan Griffith, has already sponsored a bill (H.R. 5812) that passed from the House to the Senate in June on enhancing states’ Prescription Drug Monitoring Programs, ahead of a larger, catchall House bill (H.R. 6) which aims to address prevention and treatment of opioid usage.

But there is still much to be done. Experts have criticized the catchall House bill for not effectively addressing the scope of the opioid crisis. It focuses heavily on preventing the prescribing of opioids without giving adequate treatment options for current addicts. Future measures will need to be taken that will ensure funding for treatment facilities, support a greater diversity of treatment options, and encourage further state Medicaid expansion. Griffith’s opponent in November’s race, Anthony Flaccavento, would also introduce legislation to broaden the Drug Court system that is already proven helpful in supporting recovering addicts in the NRV instead of jailing them. He’d introduce legislation to penalize pharmaceutical companies that have pushed opioids on providers without adequately educating them on addiction risks. But no matter who wins in November, we ought to encourage our representative, knowing the rate that opioids have saturated our region. Encourage them to work with representatives from neighboring districts with high prescribing rates, like Kentucky’s 5^th, Tennessee’s 1^st, and West Virginia’s 3^rd. To craft legislation that holds federal attention on the very real opioid problem that our region has. And to help those of us who call the 9^th our home have every tool we need to overcome the life shattering hardships of this epidemic.