Albion, Mich., is an underwhelming place for someone from Metro Detroit. Aside from the small — very small — private liberal arts college that bears the city’s name, there is not much else. Beyond Albion College’s campus, you will find rows of dilapidated houses with peeling paint. Driving through Albion, you get a sense that the city has seen much better days. In fact, if you drive through any number of Michigan cities, you get the same feeling. Detroit’s ongoing comeback story is a towering achievement for the state, but outside of the economic engines of southeast Michigan and Grand Rapids, the picture is not an optimistic one. Cities like Albion, Jackson and Monroe do not have their own comeback stories.

Albion is located in Calhoun County, which also contains Battle Creek, home of Kellogg’s Cereal. One of the 17 counties in Michigan where there are more prescriptions than there are people, Calhoun County has one of the highest rates of opioid prescriptions in the state. When the media covers the opioid epidemic, they depict working class folk in rural and rundown urban areas devoid of hope. It’s the same stereotypical habitat of Donald Trump voters, but that is another matter for another time.

Now, there is a common sentiment that criticizes American society for meeting the current drug crisis with empathy and concern: a stark contrast to the police crackdown and demonization of people of color during the crack epidemic of the 1980s and 1990s. There is no question that the racist War on Drugs has destroyed and continues to destroy Black and Latino lives and families. It is deeply unfortunate that the U.S. did not take the same approach with crack as we are taking with opioids, an approach rooted in public health instead of criminal justice. Ta-Nehisi Coates author of the bestseller “Between the World and Me”, is right when he speculates about how different the current opioid epidemic would be if society had invested in a substance abuse treatment infrastructure in 30 years ago.

Similar to previous epidemics of crack cocaine and methamphetamine, the opioid epidemic hammers the working class and the poor. According to national 2016 data analyzed by the Kaiser Family Foundation, West Virginia has the highest rate of opioid overdose deaths (Michigan ranks 11th). There is not a lot of good data directly on the rates of opioid misuse in America, so I like to use prescription rates and overdose death rates as proxies. These proxies are far from perfect, though. Case in point, only a small portion of opioid users overdose and even fewer die as a result. Risk of death is also highly dependent on external factors such as whether the incredibly deadly opioid fentanyl has made it into the community.

The opioid epidemic should be viewed as a  socioeconomic issue as well as a public health issue. The trend generally holds that opioids hit poorer communities harder. Moreover, treatment for addiction can be expensive and hard to access. For example, there are no specialty clinics that dispense methadone, one of the drugs used in medication-assisted treatment, in the entire Upper Peninsula.

So, why do people of lower socioeconomic status shoulder a greater burden in this epidemic? After all, oxycodone has the same addictive potential whether it is taken by a billionaire or someone who is unemployed.

By and large, people who become addicted to opioids begin with opioids prescribed to them by a medical professional for pain. Working class people are at a much greater risk for pain than their middle- and upper-class counterparts.

A major cause of pain is workplace injury, and certain jobs are far more dangerous than others. A study out of Massachusetts, which has also been hit hard by opioids, found physically-intensive occupations like construction, fishing and material moving have a much higher risk of opioid misuse and overdose death. It may surprise some but fishing is the most dangerous job in America, according to data from the Bureau of Labor Statistics. Turns out cushy desk jobs result in a less painful life.

Another way people are exposed to opioids is after dental surgery such as tooth extractions and root canals. The fact that many Americans, 21.3 percent to be exact, have not seen a dentist in several years never ceases to amaze me. Oral health is an important part of overall health, but because dentistry is separate from medicine (the reason behind this is ridiculous), 33 percent of Americans do not have dental coverage. While we are lucky in Michigan to have expanded Medicaid, which covers dental care, lower income residents of states like Texas, Florida and Georgia do not have this option. Rotting teeth are extremely painful, but they are completely preventable, as are the surgeries needed to fix them. Dentists, love them or loathe them, have an important role to play in addressing the opioid epidemic.

I could go on and on about all the links between opioids and socioeconomic class, about how the stress of living paycheck to paycheck may lead people to self-medicate with heroin or painkillers, or how higher rates of obesity in poor communities leads to an epidemic of chronic lower back pain that is the reason many start opioids.

In the crack epidemic, society viewed those suffering with addiction as criminals. Today, the stereotype of communities hardest hit by opioids also includes the notion that these people are lazy and getting high because they are bored. Both are blatantly classist and far from the truth. Whether it is crack or opioids, America’s drug epidemics are reflections of socioeconomic inequality that plagues our nation.

Ali Safawi can be reached at asafawi@umich.edu

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