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Starting in the 1990s (following the 1980s crack addiction), the use of opioid medications began to rise for reasons surrounding patient care.[1] The introduction of opioids as prescription drugs was well-intentioned and focused on relieving patients’ pain. Another intention of introducing opioids (natural, semi-synthetic, and methadone) was to prompt other clinicians and healthcare organizations to focus on pain control. When prescribing this highly addictive drug, many did not account for the miscommunication or the effect it would have on the doctor-patient relationship. Patients relied on their doctors not only for medical expertise but also for empathy, understanding, and judicious prescribing practices. Conversely, doctors depended on patients to provide accurate information about their pain levels, medical history, and potential substance use, fostering a relationship built on mutual respect and transparency. According to Arch Woodard from Allens Grove Wisconsin, a rural town, many doctors began turning away patients because of their lack of transparency when searching for opioids.[2] This caused many patients (especially in rural America) to resort to risky options to manage their main or newly developed drug addiction by seeking help from friends and family or turning to heroin.[3] In general, through the 1990s in both rural and urban America, the impact of both illicit drugs and prescription drugs has been perverse. Therefore, throughout my journalistic essay, I will discuss the risks of a drug overdose, its economic impact, and healthcare disparities in the rural United States.

Impact of Drug Abuse on the Doctor-Patient Relationship

The opioid crisis in the United States remains a serious public health issue, where there is a rise in overdose deaths at a concerning rate.[4] Most of these deaths are stemming from opioids. But through time, drug abuse has worn down the doctor-patient relationship in all parts of America. Because of this opioid crisis and persistent drug use, people struggling with addiction are more likely to hide their drug use or manipulate their prescriptions, leading to a breakdown in trust between them and their doctor. The tragic reality of drug addiction is that less than 13% of people received any treatment for their addiction in 2019 and just 18% of people with opioid use disorder received safe and effective life-saving medication that aided in their recovery.[5] Also, these patients who suffer from addict behavior, typically fall through on their appointments and treatment plans which puts a strain on the doctor and their healing process. Doctors begin to develop their stigmas surrounding patients who suffer from addiction. Many healthcare providers may fail to understand the complexity of addiction and lack empathy. Overall, drug abuse and drug epidemics significantly complicate the doctor-patient relationship.

The Doctor-Patient Relationship in Rural America/Urban America

The themes in Tweedy’s book, Black Man in a White Coat, highlight the struggles rural Americans face in managing their health without adequate care. However, some parts of rural America boasted a unique doctor-patient relationship compared to urban America, characterized by familiarity. Doctors in these areas were often closer to their patients, and more likely to know them and their families personally. This familiarity bred trust, allowing doctors to gain a deeper understanding of their patient’s medical history and individual needs. With limited access to specialists, general practitioners in rural communities had to handle a wider range of medical issues. Additionally, many rural families grappled with financial constraints, often due to higher poverty rates, impacting their ability to afford healthcare. Debbie Smith’s story from Down Home, NC, serves as a poignant example.[6] Despite her efforts to seek assistance for her drug addiction, she was turned away, underscoring the challenges faced by rural communities. Even as political figures like Mark Walker emphasize the importance of aiding addicts, actions like voting to reduce drug treatment programs contradict these sentiments, further exacerbating the struggles of rural families.[7]

In urban America throughout the 90s, the doctor-patient relationship was a mixed bag, shaped by the individuals who lived in these spaces. Healthcare connections can differ depending on the circumstances of each patient, especially in America’s urban areas where diversity is more prominent. Nonetheless, both in urban and rural settings, the core values of patient-centered care and medical ethics apply. Healthcare practitioners in both locations work to solve distinct obstacles, such as physician shortages in rural areas and urban overpopulation, and provide high-quality care. Healthcare gaps between urban and rural areas are lessened by advances in telemedicine. Even though the foundations of healthcare may be similar, efforts to alleviate disparities must continue, with a focus on each community’s particular requirements. There were equal challenges in urban America for there was a rise in “managed care” during the 1990s. Many doctors during this time were displeased with their professional autonomy being reduced, and patients did not like that they had fewer choices of doctors and hospitals.

Solutions and Recommendations

Opioids including prescription drugs (oxycodone) and other illegal drugs are extremely addictive. After their debut in healthcare in the 1990s, the increased availability of illegal opioids such as heroin has increased as well.[8] Solutions to fixing the doctor-patient relationship from the consequences of drug abuse start with reducing the flow of illicit opioids. Then, limiting prescription opioids, promoting treatment, and de-stigmatizing drug addiction. There are no simple solutions to reducing the flow of illicit opioids but in some communities, they are investing funding for law enforcement that targets large-scale opioid distribution.[9] Strategies that promote treatment include Medicaid expansion since many states have expanded Medicaid under the Affordable Care Act. [10]Any low-income individual can enroll in Medicaid and, therefore, have access to treatment options such as medication-assisted treatment (MAT).[11] To reduce the harm of opioids, educate individuals about Naloxone. Naloxone is one of the most important drugs because it can reverse the side effects of overdose and is widely available for use. Overall, to contribute to the building of the doctor-patient relationship, we have to start with helping the patient.


The intertwining issues of drug abuse and inadequate healthcare have left an indelible mark on the doctor-patient relationship across America, both in rural and urban settings. The well-intentioned introduction of opioids for pain relief has inadvertently led to an epidemic of addiction and mistrust, undermining the foundational principles of trust and effective communication that should characterize this crucial relationship. Rural areas, with their unique challenges of limited access to specialists and financial constraints, have borne a disproportionate burden, forcing many to resort to risky alternatives. Meanwhile, in urban settings, the rise of managed care has further complicated the landscape, reducing both doctor and patient autonomy. The opioid crisis has not only led to a surge in overdose deaths but has also eroded the trust between patients struggling with addiction and their healthcare providers. The resulting breakdown in communication and honesty further strains the doctor-patient relationship, making effective treatment more elusive. Only through collaborative efforts and compassionate approaches can we hope to restore the integrity of the doctor-patient relationship and ensure that all Americans receive the quality care they deserve.


[1] CDC. 2021. “Opioid Data Analysis and Resources | CDC’s Response to the Opioid Overdose Epidemic | CDC.” June 22, 2021.

[2] “Y-0079.” Southern Oral History Program Interview Database. Accessed April 23, 2024.

[3] “Y-0079.” Southern Oral History Program Interview Database. Accessed April 23, 2024.

[4] Division (DCD), Digital Communications. 2022. “National Opioids Crisis: Help and Resources.” November 14, 2022.

[5]  Volkow, Nora, By, Nora Volkow, and Nov. 2. “To End the Drug Crisis, Bring Addiction out of the Shadows.” AAMC, November 2, 2021.

[6] Smith, Debbie . n.d. Interview by Isabell Moore.

[7] Smith, Debbie . n.d. Interview by Isabell Moore.

[8] U.S. Department of Justice. 2016. “Opioid Facts.” September 12, 2016.

[9] U.S. Department of Justice. 2016. “Opioid Facts.” September 12, 2016.

[10] CMS, Data. n.d. “Centers for Medicare & Medicaid Services Data.”

[11] CMS, Data. n.d. “Centers for Medicare & Medicaid Services Data.”

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