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U.S. drug overdose deaths, which have been concentrated in Appalachia and other rural areas for more than a dozen years, are back to being most common in big cities, according to a government report issued Friday (Source: “Cities now see more overdose deaths than rural areas,” Associated Press, Aug. 2, 2019).

The report by the Centers for Disease Control and Prevention said the urban overdose death rate surpassed the rural rate in 2016 and 2017. Rates for last year and this year are not yet available. But experts, citing available data, say the urban rate is likely to stay higher in the near future.

The difference between the urban and rural counties was not large. In 2017, there were 22 overdose deaths per 100,000 people living in urban areas, compared with 20 per 100,000 in rural areas.

The epidemic was initially driven by opioid pain pills, which were often as widely available in the country as in the city. But then many drug users shifted to heroin and then to fentanyl, and the illegal drug distribution system for heroin and fentanyl is more developed in cities, according to said Dr. Daniel Ciccarone, a drug policy expert at the University of California, San Francisco.