According to the Centers for Disease Control and Prevention, or CDC, about 108,000 people died from drug overdoses in the U.S. during 2022. About 76 percent of that count involved opioids.

The opioid crisis has devastated countless families nationwide. And as Johnson County Public Health reported in 2023, the crisis extended its lethal touch to Johnson County, claiming the lives of 10 residents. 

While controlled opioid use is necessary for some groups, such as veterans struggling to manage their pain, a recent VA Health Care study found there is a great deal of discrepancy as to who the pills are prescribed to. 

The study that ran from 2016 to 203 found that veterans living in rural communities were prescribed opioids 45 percent more often than their urban counterparts to treat chronic pain. 

While the researchers involved say that the study is simply observational, it could point to rural veterans’ more significant need for access to pain management. 

Johnson County Paramedic Matt Tracy didn’t need the help of a study to come to that conclusion. As a former Marine who served two tours in Afghanistan, Tracy was offered opioids to treat chronic pain in his knees and back but refused.

“I’ve been a VA patient now for 15 years,” he said. “I feel that veterans in the rural area don’t have what the urban areas have due to the fact that there’s just nothing there. You have to drive to do these things. You have to drive 40 minutes to an hour to go to [the VA].”

Coming from a small town himself, Tracy feels isolation plays a significant role in opioid addiction among veterans. He also believes it exacerbates other addictions like alcoholism, which he struggled with shortly after being discharged.

“You have more bars than you do churches in a small town,” he said. 

Tracy recommends rural veterans reach out to local primary care providers instead of relying solely on the VA’s care. He also sees adding ketamine clinics to small towns as a potential solution. 

“Our primary pain for pain control at the ambulance is ketamine,” he said. “We don’t go straight to fentanyl. We don’t go straight to morphine. We go straight to ketamine due to the opioid crisis.”

Tammy Wigim, who served as a paramedic with Mahaska Health Partnership in Oskaloosa, Iowa, from April 2004 to June 2020, knows all too well the uphill battle veterans face with opioid abuse. 

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“Their frustration was, number one, getting into the VA, and number two, [they would say] all they do is send me off with this huge bottle of pills. I already feel bad enough, but hey, I could kill myself if I wanted to. That was a quote I heard often,” she said. 

Johnson County Paramedic Michael Mothershed could only speculate as to why rural veterans are prescribed opioids more frequently. As the lead paramedic for the Johnson County Mobile Integrated Health Program, Mothershed meets residents who continuously call EMS at their homes to identify their health needs.

“I would think the reason that [the VA] is dispensing large quantities is to make sure the patient is set for a long time, so they don’t have to be coming back and forth those large distances for care,” he said. “If someone is completely dependent on the VA for their health care, they would use the VA pharmacy.”

Mothershed also mentioned the challenges of coordinating care for his veteran client, particularly since he doesn’t have access to the VA’s medical records system. Mothershed and Wigim agreed that better communication from the VA to mobile health is needed for mobile health to run smoothly. 

Johnson County Public Health Director Samuel Jarvis hopes that providers are not only exploring all of the clients’ options that may make opioids unnecessary but also educating and equipping them with Narcan, a life-saving medication used to stop opioid overdoses. 

“We’re hoping that providers are being able to take the time with their patients to describe how that’s working for them,” he said. “Are there ways that they can find other pain management methods? Whether it’s a mixture of things that are over the counter, are there other physical activities they could do?” 

Jarvis said Johnson County’s public health team recently received a grant from the state health department to address opioid use. They will be collaborating with the Abbe Center for Mental Health, providing a peer recovery coach and academic detailing to enhance pain management options for providers and patients.