Differences in Perceived Difficulty in Obtaining Illegal Drugs By County Population Size

Background and Purpose: Differences in substance use patterns and outcomes between urban and rural areas have become a growing area of research, with residents of rural counties having higher rates of opioid fatalities than their urban counterparts. The purpose of this study is to examine the differences in perceived difficulty in obtaining different illegal substances as a means of further understanding the divide between metro and non-metro substance use outcomes.

Methods: Data for this study come from the 2022 National Survey on Drug Use and Health, with a sample of n=45,614 adults. County population size was operationalized using the Rural-Urban Continuum Codes: large and small metro/urban areas and nonmetro/rural. Respondents were asked, “How difficult or easy would it be for you to get some heroin, if you wanted some?” with potential answers including 1= Probably impossible; 2= Very difficult; 3= Fairly difficult; 4= Fairly easy; and 5= Very easy. Responses were collapsed to form a dichotomous dependent variable with 1= Fairly/Very Easy and 0= All other responses. Similar questions were used to obtain perceived difficulty in obtaining cocaine, LSD, and marijuana. Chi-square tests were used to examine bivariate relationships between county size and difficulty in obtaining substances. Logistic regression models were created to examine the increase in the likelihood of obtaining different substances while accounting for sex, age, race, marital status, income, and past-year use of illegal drugs.

Results: Around 46% of the sample lived in a county classified as large metro, 40% in small metro counties, and 14% in nonmetro areas. Around 65% of the sample reported it would be fairly/very easy to obtain marijuana, followed by cocaine (18.6%), then LSD (14.3%), and lastly, heroin (12.8%). Chi-square tests showed a significant bivariate relationship between county size and difficulty in obtaining marijuana (X²= 8.22, p < 0.05), LSD (X²= 11.70, p < 0.01), and heroin (X²= 33.01, p < 0.001), but not cocaine (X²= 3.50, p > 0.05). Logistic regression models revealed that nonmetro areas were significantly more likely to report fairly/very easy difficulty in obtaining heroin than large metro (AOR= 1.15, CI= 1.06 – 1.25) or small metro counties (AOR= 1.13, CI= 1.05 – 1.22). However, the opposite was true for LSD and marijuana, with large metro (LSD: AOR= 1.15, CI= 1.06 – 1.25; marijuana: AOR= 1.18, CI= 1.10 – 1.25) and small metro counties (LSD: AOR= 1.09, CI= 1.01 – 1.18; marijuana: AOR= 1.08, CI= 1.01 – 1.15) showing a significantly greater likelihood in reporting easier obtainment than nonmetro counties. No difference was observed in difficulty for cocaine.

Conclusions and Implications: Not only do rural communities experience greater barriers to healthcare and are more likely to be prescribed opioids, but this study indicates that they also report easier access to heroin. Considering the increased lethality of drug poisonings in rural areas, the results from this study provide further evidence of the need for interventions to prevent initial opioid exposure and promote access to treatment in these communities.