US cities again see more overdose deaths than country town

In this Wednesday, Aug. 23, 2017 file photo an unidentified heroin user, left, is injected by another man, right, on the street near a strip of land sometimes referred to as "Methadone Mile," in Boston. Fatal drug overdoses in the U.S. were long known as being most common in big cities. That changed 13 years ago, when Appalachia and other rural areas started seeing the nation's highest overdose death rates. According to a government report released on Friday, Aug. 2, 2019, it's shifted back again. (AP Photo/Steven Senne) In this Wednesday, Aug. 23, 2017 file photo an unidentified heroin user, left, is injected by another man, right, on the street near a strip of land sometimes referred to as "Methadone Mile," in Boston. Fatal drug overdoses in the U.S. were long known as being most common in big cities. That changed 13 years ago, when Appalachia and other rural areas started seeing the nation's highest overdose death rates. According to a government report released on Friday, Aug. 2, 2019, it's shifted back again. (AP Photo/Steven Senne)

By Associated Press August 2, 2019 3 min read

NEW YORK (AP) – U.S. drug overdose deaths had been most common in Appalachia and other rural areas in recent years, but they are back to being more concentrated in big cities, according to a government report Friday.

The Centers for Disease Control and Prevention found that both urban and rural overdose death rates have been rising, but the urban rate shot up more dramatically after 2015.

That probably is due to a shift in the current overdose epidemic, said Dr. Daniel Ciccarone, a drug policy expert at the University of California, San Francisco.

The epidemic was initially driven by opioid pain pills, which were often as widely available in the country as in the city. But then many drug users shifted to heroin and fentanyl, and the illegal drug distribution system for those drugs is more developed in cities, Ciccarone said.

Another possible explanation: rising overdose deaths among blacks and Hispanics, including those concentrated in urban areas, he added.