Similar but different: The opioid epidemic across America


This story pairs with “Recovery through connection and education: A look at the opioid epidemic in Utah

Commonly used medication sits behind a locked glass door. Pain medication is often prescribed or abused, sometimes leading to opioid addiction. (AP Newsroom)

Baltimore County, Maryland. Utah County, Utah. Central Appalachia. What do these three places have in common? On the surface, very little. But all three are fighting an epidemic. 

Each of these areas has seen a dramatic increase in opioid-related deaths. According to a recently-updated Washington Post investigation, from 2006 to 2014, 127,891,644 prescription pain pills were sent to Utah County. 

Baltimore County received 278,415,178 pills and Kanawha County in West Virginia received 123,296,960 pills.

Despite these rising numbers, there are still many differences in how these areas are affected and how they have reacted and responded to the opioid epidemic. Here are a few:

Affected population

Utah’s population of people suffering from opioid addiction, something West Virginia University psychology professor Jonathan Stoltman calls a treatable chronic disease, is mainly white upper- and middle-class, educated individuals. 

In Baltimore County and West Virginia, low income and poverty-stricken populations are hit hard by opioid abuse. There are less upper- and middle-class people misusing opioids and other drugs like heroin. 


In Utah, most opioid-related deaths resulted from prescription opioids, according to a 2019 report from the Utah Department of Health. Heroin was the second in drug-related deaths.

Baltimore County and Central Appalachia typically see less prescription-drug usage and more heroin usage as well as other drugs. Typically opioids just begin the journey into drugs in these areas, whereas in Utah many people stick with prescription pills. “Even if you start on an oxy addiction, you gravitate to the cheaper drugs like heroin and cocaine,” said Doug Finch, a deputy county attorney for Utah County.

According to the Maryland Department of Health, there were 758 fentanyl-related deaths in 2018. Utah had 92 deaths. 

Fentanyl is a synthetic opioid illegal to make and use, according to the National Institute on Drug Abuse. In 2017, 59% of opioid-related deaths nationwide involved fentanyl. 


A major difference between Utah and West Virginia and Maryland is the stigma surrounding opioid misuse. Jon Redd said Utah is unique in the opioid epidemic in the sense of culture and the role shame plays in addiction and recovery. 

“People have this disease but may not be comfortable talking about it. They don’t look at it as a disease but as a moral weakness,” he said.

Redd suffered from the disease of addiction for many years before entering Renaissance Ranch, a rehabilitation center in Salt Lake County. He now runs community outreach for the center.

Judge Michael Aloi, a U.S. magistrate judge for the Northern District of West Virginia, was one of the first West Virginia judges to begin a drug court program at the state level. He said often courts prey upon the most vulnerable people in society. “We can’t put everyone in jail for what is an illness,” he said. 


Utah was quick to respond to the opioid epidemic as a public health crisis. “If you believe that addiction is a disease, and that a part of that disease also includes relapses, then locking people up because they’re trying to combat this disease just doesn’t necessarily make sense,” said Malyce Warner, a former prevention specialist at the Utah County Department of Drug and Alcohol Prevention and Treatment.

Maryland and West Virginia have typically responded with criminalization. “The biggest problem is that we made addiction a crime and we built an industry around it,” Aloi said. 

Redd said he looks at opioid misuse as a disease and thinks it should be treated like a disease. “This is a disease of behavior. The way people notice this disease is by poor behavior,” he said. “When we look at it as criminalization, we’re not addressing the problem. We’re not providing them support and help as a personal level.”

Aloi said what gives him hope is a movement called treatment courts made up of teams of public defenders, law enforcement, educators, recovery coaches, mental health counselors and homeless shelter leaders.

“I think we have a criminal justice system that is structurally inadequate to handle problems brought to them today,” he said.

Regardless of differences between these three places, the underlying similarity is the extremity and danger of the disease of opioid addiction sweeping the nation. Maryland, West Virginia and Utah could all learn from each other how to approach, treat and prevent future opioid-related deaths and misuse.

Read more from this series:

Recovery through connection and education: A look at the opioid epidemic in Utah

Reporter’s notebook: Connecting through differences

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