According to USDA economic researcher David McGranahan, the opioid epidemic that has plagued America, particularly rural areas, over the past two decades appears to have had two distinct phases.

"Think about these two phases as part of the same epidemic almost. They involve opioids but their geography is is completely different, and the populations affected are fairly different."

A recent USDA study shows misuse of prescription opioids centered primarily in rural areas the first decade of this century. More sever in locales with high disability rates impacting mostly working-age citizens. Yet, starting in 2011, use and misuse of elicit opioids such as heroin and fentanyl  grew some in rural areas yet, "the epidemic kind of shifted to urban areas." primarily, he noted, in the Northeast corner of the country.

McGranahan that adds use of opioids outside of metro areas focused in communities along interstate highways due to easier access, than to more remote rural areas.  

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