I wouldn't go that far. What you can see on those maps is that major cities seem to be less impacted. My hunch is that the opioid/heroin epidemic had already been impacting major cities thus they have a different baseline. The three factors here are disability, employment and pill use. I think many of the impacted areas relied on heavy industry with physical labor. As the mines/factories closed it left behind a lot of people with chronic injuries from their occupation (like chronic lower back pain). So where jobs went away, people got depressed that makes pain a lot worse (depression recalibrates pain perception, making it much more unbrearable). This is where prescription opioids come in, they keep people hooked and out the work force.
The epidemic was very obvious, even in 2014, there was an editorial in one of the leading journals showing how opioid-related deaths surpassed motor vehicle accidents amongst young people. When White people start dying, it can't be ignored so while the war on drugs was OK to inflict asymmetrical pain on minorities, you can't find a group that the same approach would be popular with if that starts majorly hitting Whites.
The documentary was pretty good, BTW, but didn't cover some of the super major aspect of the systemic issues. Medicare reimbursements and HCAHPS scores, where patients reported on satisfaction with care at a hospital. A random websites recommendations how to keep patient satisfaction up:
High patient satisfaction scores and HCAHPS reimbursement go hand-in-hand, underscoring the need for robust patient experience strategies.
www.relias.com
I've had more than 10 situations as a resident where a patient was demanding opiates in the hospital and if you put your foot down, you get intimidated by some worthless, overpaid administrator... In a good hospital you can chisel them off your back easily, sometimes they are even helpful, but in a shitty hospital they are going to try to intimidate you into prescribing hydromorphone (Dilaudid, a 20x more potent than herion kind of narcotic). Some savvy patients actually target teaching hospitals because of inexperienced residents are much more shy telling admins to fuck off.
It's also a major ethical dilemma, and the moment somebody tries to compare the patient to a consumer I tell them to fuck off. I have a lot higher standard and stricter moral obligations than McDonalds. There's data to show that patients who are more satisfied with their care have higher complication rates and utilize more resources. I can get anybody hooked on Dilaudid and make them very happy with me, yet it's often times the worst service I can do to the patient.
