Connie Gyorr and her husband, John, grow soybeans, corn and sunflowers in central Illinois. With a small herd of Boer goats and an assortment of other animals, the farm was an idyllic place to raise their three children.
But it couldn’t insulate them from the opioid crisis in rural America.
They lost their 20-year-old daughter, Marisa, to a drug overdose on May 11, 2016. She had been out with a young man and overdosed in his car on cocaine laced with fentanyl. Afraid to take her inside the hospital he had driven to, the man took her to a wooded area and left her there to die.
“It’s a parent’s worst nightmare,” Connie Gyorr said.
She was cooking dinner when she got the call. She passed out, hit the floor and came to amid chaos.
The baby was screaming. Her son, then in his early 20s, didn’t know what was happening and was frantically calling out for John.
Gyorr said she struggles with the pain and loss every day.
“Marisa was just too young. There was so much she wanted to do, and it was taken away in a flash,” she said.
Marisa was one of more than 63,600 Americans that year who fell prey to the drug epidemic that has overtaken much of the U.S.
The Centers for Disease Control says 2 out of every 3 drug overdose deaths involve an opioid. Opioid deaths — involving prescription opioids, heroine and synthetic opioids such as fentanyl — have increased nearly six-fold since 1999.
Of the more than 72,000 total overdose deaths in 2017, opioids were involved in more than 47,000 — about 68% — and 36% of those involved prescription opioids.
The problem is not confined to big cities. Opioids are found even in the smallest towns and the most rural settings, contributing to the climbing overdose death rates in rural areas, which first overtook urban areas in 2004.
From 2013 through 2017, nearly 170,000 people were killed by opioids — a population about the size of Salem or Eugene, Ore. About 12.5% of those were in rural communities, where the number of deaths from opioids increased 36.6% from the previous five years.
In the rural Pacific Northwest, 2,255 people died from dug overdoses between 2008 and 2017 — and 60% involved opioids.
A life cut short
Marisa MacDuff loved the farm and the animals. She was a barrel racer, a straight “A” student, involved in her church, loved to sing and dance, had a smile that could light up a room, and her laughter was contagious, said her mother, who was remarried and has a different last name. She was generous and strong-willed.
She loved to bake and sold her goods at the farmers’ market. She was a strong swimmer and enjoyed the outdoors and fishing. She was involved in many different activities and was always in the local newspaper.
“She was amazing. She was very free-spirited. She could do anything (and) she just wanted to do it all,” Gyorr, her mother, said.
But none of that protected her from falling victim to a drug overdose.
Gyorr didn’t find out what had taken her daughter’s life for 10 weeks, and when she did she didn’t even know what fentanyl was.
Fentanyl, she learned, is a powerful synthetic opioid 50 to 100 times stronger than morphine. Illicitly manufactured fentanyl is also cheap and readily accessible.
Gyorr has always had an open-door policy with her children but had no idea Marisa was using drugs.
“There were some red flags now that I look back. If I knew then what I know now, I would have dug deeper,” she said.
Marissa was attending cosmetology school in a town three hours away and working part-time. Gyorr would make plans to visit her, only to have Marisa cancel, saying she had had a “bad night” due to her diabetes.
“Did I put it together? No, not at all,” she said.
In addition to her shock and grief, Gyorr struggled with feelings of embarrassment and failure as a parent.
“That stigma affected me, and I didn’t want to talk about it. But I realized I had to talk about it. I had to tell people how she died if I was going to help anyone else and prevent another tragedy,” she said.
Rooting out the problem
A few years back, officials at the American Farm Bureau Federation had been hearing a lot anecdotally about the burgeoning opioid issue in rural communities and wanted to do something about it. But they didn’t have a firm grip on the crisis — or how to help.
“It’s such a huge issue, you don’t know where to start,” Ray Atkinson, AFBF director of strategic communications, said.
The one thing Farm Bureau officials did know was the issue was too big to address alone. So they teamed up with National Farmers Union to think strategically and develop a plan.
The two organizations aren’t always aligned on policy issues. But the opioid crisis is common ground, and they wanted to work together to address it.
They commissioned Morning Consult to survey rural adults in October 2017. What that survey found was that 3 in every 4 farmers and farmworkers are or have been directly impacted by opioid abuse.
“That was a pretty big wake-up call for us,” Atkinson said.
About the same number of farmers and farmworkers said it would be easy to obtain opioids without a prescription. Yet the majority thought urban areas were impacted more by opioid abuse.
The survey also found the stigma of opioid abuse in rural communities was a major barrier to overcoming addiction.
Armed with that information — as well as other perceptions about opioid abuse and obstacles to recovery — the groups had a better understanding of the severity of the problem and how they could help.
They launched “Farm Town Strong” in January 2018. The campaign is anchored in the strength of farmer-to-farmer support and the resilience of rural communities to overcome the crisis.
The groups wanted to make it about hope, finding help and talking neighbor-to-neighbor. One focus was to knock down the stigma of opioid abuse, Atkinson said.
“That was really the thing generating these conversations. If people can’t talk about it, people are suffering in silence,” he said.
Farmers don’t typically ask for help, and that’s where the farmer-to-farmer conversations are so important, he said.
AFBF and NFU encouraged their members to start the conversation and talk with neighbors.
They also teamed up with USDA in its efforts to combat the problem, participating in the agency’s community roundtables to hear first-hand how the issue impacts rural communities.
USDA is a trusted source for farmers and rural America, and partnering with the agency was really important in the groups’ efforts, giving the campaign credibility and a higher level of impact and outreach, he said.
“I think that really had an impact on people — this really is a serious issue and people are trying to help,” he said.
AFBF and NFU have been focused on driving the conversation, helping people understand how to get help.
“Stigma is still the biggest challenge,” he said.
Moving the needle
The farm groups’ efforts to raise awareness and eliminate the stigma are making progress. In a follow-up survey by Morning Consult in 2019, there was a 17% increase in farmer and farmworker awareness that opioid abuse is a major problem in rural communities.
There was also a 16% decline in farmers who thought opioid abuse was something to be ashamed of and a 3% decrease in the number of all rural adults saying there is a great deal of stigma associated with opioid abuse.
“It’s definitely encouraging. First of all (is) the awareness, you can’t understand the scope of the problem if you think it’s happening somewhere else,” Atkinson said.
Lack of awareness also contributes to the stigma, with people thinking they’re the only one in farm country with the problem, he said.
“The decrease in shame is big, too. People are starting to realize it’s not something to be ashamed of; it’s a disease affecting a lot of people,” he said.
Farmers are stoic and self-reliant. Those attributes that make them good farmers also make it difficult for them to seek help, he said.
“I really believe the Farm Town Strong campaign has had an impact on how people think about that,” he said.
The collaborative partnership with NFU was “key to our success in demonstrating a measurable impact on awareness and perceptions of the opioid epidemic in rural America,” he said.
Farming communities have been hit especially hard by the opioid crisis, Mike Stranz, NFU policy director, said.
“It’s imperative for organizations that represent rural America to work together to overcome this challenge. Farmers Union and Farm Bureau have done just that with Farm Town Strong. We’re happy to join forces any time we can on such a critical issue,” he said.
In 2019, the Farm Town Strong campaign was recognized by the Public Relations Society of America for having a significant impact in promoting life-saving prevention and treatment information, reducing stigma and influencing public opinion about opioid addiction in rural America.
In addition to sparking conversation and breaking down stigma, the campaign provides resources to farm families and rural communities on prevention, treatment, disposal and hotlines.
“I think progress has definitely been made. Obviously, there’s still a long way to go,” Atkinson said.
With more than 70,000 overdoses in 2017 —about 200 every day — the White House Office of National Drug Control Policy was fully aware the country had a crisis on its hands.
Farm Bureau and NFU drew the agency’s attention to the severity of the problem in rural areas, particularly with opioids, said Anne Hazlett, NDCP’s senior adviser for rural affairs.
“The rural community has really been affected by the crisis,” she said.
The Journal of the American Medical Association reported that researchers found people in these communities were as concerned about drugs in their community as the economy, she said. Several factors could be contributing to the increase in drug addiction and overdose death rates in rural areas, she said.
“No two rural places are the same, but I do think there are some common themes,” she said.
Physical labor that leads to injuries is one. The lack of access to health care — such as physical therapy or other alternatives to medication — is another.
“Those resources just aren’t always there in a small town,” she said, and a primary-care doctor may simply give someone a medication to manage the pain.
Two medications often prescribed for pain are oxycodone and hydrocodone, which if misused can lead to addiction. Along with methadone, they are the most common drugs involved in prescription opioid overdose deaths, according to the CDC.
As many as 1 in 4 patients receiving long-term opioid therapy in a primary-care setting struggles with addiction, the agency says.
When the prescription runs out, an addicted person might turn to the street to find illicit opioids such as heroin or fentanyl.
In addition to challenges with pain management, another common theme in what might be driving the addiction issue in rural American is a challenging agricultural economy or lack of economic opportunity. Some people feeling that despair choose to self-medicate, she said.
Access to mental-health care is even more challenging than access to health care for physical ailments. Telemedicine can help, but some people feel uncomfortable with it and the needed broadband internet connections are not always available in rural areas, she said.
But there is reason to be optimistic. The Trump administration and USDA are focused on making resources available to rural communities to address the crisis, she said.
“We absolutely believe progress is being made. Where I have a lot of hope is what I see happening in communities,” Hazlett said.
What really brings change is local action in the community or county, and that’s happening, she said.
Just as there are common themes behind addiction in rural communities, there are common ingredients for success.
Eliminating the stigma around addiction is essential. A community can have the health care people need — but if they don’t share that they have a problem, lives will continue to be lost, she said.
“It’s a huge challenge,” she said.
Farm Bureau and NFU have been incredibly helpful in that effort. Talking to their members about this issue has really been impactful, she said.
There also has to be local leadership to prevent and treat addiction. That can take many forms, such as the local medical community, sheriff’s department or county Farm Bureau, she said.
And there has to be communication between different groups trying to address addiction in different ways.
“You really have to have everyone at a common table and working together,” she said.
Unfortunately, right now the metric in terms of outcomes is the number of lives lost, she said.
Those deaths were down 4.1% nationwide in 2018 compared to 2017, according to the CDC.
“But we need to look at whether someone is looking for help.” Whether it involves addiction or mental health, “we want to see people seeking care,” she said.
And there is some positive data in that regard. Nationwide, addiction treatment in 2018 was up 38% from 2017, she said.
In addition, prescription rates for opioids were down 34%, and there was a record level of investment in prevention, treatment and drug control — $36.8 billion across all federal agencies.
The issue is daunting. But especially in rural communities, it has to be addressed because their future is riding on it, she said.
It’s having a huge impact on rural economies and services. Many rural communities are already strapped when it comes to such things as infrastructure needs, emergency response and roads, she said.
“The stress this issue has placed on local government is tremendous. It has to be dealt with to mitigate that impact,” she said.
After Marisa’s death, Gyorr began researching the drug issue and started Marisa’s Purpose, a foundation to educate families, teachers and students on the risks and to prevent more tragedies.
“All I can do is to try to educate parents — don’t ever, ever think it can’t happen to your family,” she said.
Education has to start young and be more than “Just say no to drugs,” she said, adding that it needs to inform students about the dangers of drugs in a detailed description of what can happen.
“Education and prayer are going to be the two things that help us get through this,” she said.
Marisa’s burial plot is in a small cemetery alongside a horse farm. The headstone faces a pasture of horses — one of her passions.
Gyorr also has a memorial garden for her daughter in her yard and is comforted especially by the butterflies that flit among the flowers.
Talking about Marisa, the horses and the garden causes a catch in her voice, but it doesn’t stop her.
“It’s OK to talk about it because that’s the only way people are going to get help,” she said.
One in three families in America is dealing with addiction, and people will open up about it if the conversation is started, she said.
“Don’t be embarrassed, don’t be afraid to talk about it. Don’t ever think it can’t happen to you,” she said.