PROVIDENCE, R.I.— In recent weeks, news reports of multi-million dollar settlements with opioid manufacturers raised hopes in many rural communities. This newfound optimism, however, fails to account for the underlying structural issues that limit the ability of communities in Berkshire County, among many other rural regions, to successfully manage the opioid epidemic.
The Massachusetts Taxpayers Foundation estimated statewide the cost of the opioid crisis — including productivity losses and increased health care and criminal justice expenses— at $9.7 billion in 2017. In Western Massachusetts, costs approached $1.2 billion, while in Berkshire County, costs topped $175 million. Even these staggering estimates are likely understated. Current projections do not account for foster care costs, criminal charges not strictly linked to opioids, or health care issues that arise from drug use. Even if lawsuit settlements provide additional resources to the county, several underlying challenges would still remain.
First, a lack of opportunity within the area has driven many young, skilled, and educated workers out of the county. This rural flight has resulted in reduced the human capital in our communities and contributed to the 14 percent decrease in Berkshire County's population between 1970 and 2014. Rates as bleak as these are not present elsewhere in the Commonwealth, nor are they seen in the surrounding Capital and Pioneer Districts, where populations are growing. This outmigration — paired with an aging population (over 50 percent of Berkshire County is above 45 years old) — promises to further strain our health care resources and undermine our county's economy.
Second, those who stay in Western Massachusetts struggle to find meaningful employment. Maintaining a skilled labor force remains an ongoing challenge for the community. Future generations will face a local economy that is composed primarily of low-wage jobs in retail and food services, both of which result in underemployment and pay out below-average wages compared to the rest of the Bay State. Berkshire County residents earn below-average annual pay in all 22 industry sectors, according to the Berkshire Regional Planning Committee. The four highest paying sectors, including utilities, finance, and manufacturing, employ only 12 percent of residents. Labor force participation has steadily decreased since 2009 and local unemployment rates continue to trend above the state average. Poor employment prospects contribute to higher rates of opioid abuse.
Third, the chronic problems of health care access in the nonmetropolitan communities, including Berkshire County, exacerbate these economic problems. Inadequate public transportation makes accessing limited health care services challenging. Rural health care practices face recruitment issues and instability. Recent strikes over nurse staffing levels, the closure of North County's hospital, coupled with challenges in recruiting volunteer emergency first responders, must be addressed.
The opioid epidemic is a "disease of despair." Berkshire County continues to struggle with liver diseases due to alcohol abuse, suicide, and drug deaths. All represent the scarcity of hope within our community. A study by Berkshire Health Systems revealed that the county's suicide rate outpaced the state average by approximately 140 percent since 2012 across all age groups. Drug deaths in the county have more than doubled since 2014, reaching 25.2 deaths per 100,000 people; the national average is 16.9 per 100,000. Berkshire County also leads the state in teenage birthrates, and our state's opioid epidemic is reflected in our local maternity wards. Across the state, 17 per 100,000 infants are born with opioid dependences, also known as neonatal abstinence syndrome — nearly three times the national average. However, in Berkshire County, the rate is 43 babies per 100,000. The estimated cost for each opioid addicted newborn is $93,500.
The challenges facing Berkshire County cannot be resolved through a legal settlement. Instead, we must develop a harm-reduction strategy to erase the stigma of addiction, aid victims of addiction, and address the underlying economic and structural factors that contribute to the opioid crisis in the Berkshires.
Jackson Reis, a lifelong resident of Berkshire County, is a senior in the liberal arts honors program at Providence College, majoring in Finance and Spanish. He researched the impact of the opioid epidemic on Western Massachusetts as part of a capstone honors colloquium. He has firsthand experience with the epidemic as a firefighter/EMT.