Overdose death rates in Appalachian counties remain higher for years after flooding, study shows

This coverage is made possible through a partnership between BPR and Grist, a nonprofit environmental media organization.

A new study shows a link between extreme flooding and higher rates of overdose death in cash-poor Appalachian counties in Eastern Kentucky and West Virginia. BPR spoke with Pennsylvania State University researcher Kristina Brant to understand why these tragedies become likelier after a disaster, and what can be done to reduce overdose deaths in the future. This interview has been edited and condensed for clarity.

What is the connection between flooding and overdose deaths in Appalachia?

While I was doing this work in Eastern Kentucky, the first of the big three floods that have impacted Eastern Kentucky hit. But I saw that after such a huge disaster, especially in a small community where so many people wear many hats, right? Like the same person that provides one public health service is also going to be asked to jump in on flood recovery."

My team looked at this connection between flooding and overdose deaths using both quantitative data, statistics, and also using interviews or qualitative data. We drew on opioid overdose mortality data from the National Center for Health Statistics and flood data from the National Oceanic and Atmospheric Administration to see, is there a connection between flooding events and overdose mortality?

So, they can compare all the flooded counties to all the non-flooded counties in a year.

And they find that counties that flood do experience an increase in overdose deaths and an increased overdose death rate following a flood. And the other thing that actually was even a little bit surprising to me was that that increase isn't just, it doesn't disappear in a year. Overdose deaths increase and then that persists for 10 years after the flood happens.

A severe flood can impact access to services. And it's important to have a number of important ingredients in your life, like access to a safe home, like access to a well-paid, meaningful job, like access to social support. And for many people, the flood upended those things.

In the study, you discuss the intersecting physical and mental health issues that can contribute to and complicate substance use disorder. Could you talk about how these intersecting health concerns can complicate disaster recovery too?

There are multiple other types of mental health disorders that co-occur quite often with substance use disorder, but post traumatic stress disorder is one that especially could be exacerbated or triggered by this, you know, new extremely traumatic event, right? So for folks who already experienced a lot of trauma in their lives and already were dealing with PTSD, this was just another compounding traumatic experience to add on top of that. 

So when folks are experiencing the traumatic event and suddenly are unable to get to the recovery support group that was so important to help them process their former traumatic experiences, that could amplify the vulnerability during that time too.

How does substance-use disorder prevent people from  accessing ordinary kinds of disaster recovery support —  FEMA, volunteer support, donations, food aid, et cetera?

We have been making a lot of headway on decreasing stigma, but it's certainly still the case that stigma towards substance use is quite high. So even if the majority of people are compassionate, one stigmatizing experience where someone feels like they have been labeled undeserving of support or care can keep someone from seeking help.

What lessons do you feel these discoveries have for Helene impacted communities in western North Carolina?

To mitigate the potential negative impacts of floods, it requires responses at multiple time points along the way. Time points pre-disaster, time points immediately after the disaster, and in the longer term.

Something really positive that I did hear, I was so impressed by how adaptable people were after the flood. Providers really, the folks I talked to went above and beyond to limit disruptions in care as much as they could. We still are siloed in the types of work that we do. And so, when it comes to things like flood preparedness conversations or flood recovery conversations, it's not the case that often a substance use service provider might have a seat at that table, right?

That might not be the person that we go to, the local government might go to when thinking about how to be resilient towards a flood. Some of the interventions that I think could make care easier to access generally, every day, for rural people, would also help to limit disruptions after disaster.