FILE -- Larry Gibson, whose family has owned land in the area for 235 years, stands atop Kayford Mountain in West Virginia. (AP Photo)

FILE — Larry Gibson, whose family has owned land in the area for 235 years, stands atop Kayford Mountain in West Virginia. (AP Photo)

There’s a disturbing trend in Appalachian country, a distinctive region in the eastern United States, perhaps best known for its mountain people and struggling coal mining industry. The seven Appalachian states account for more than a fifth of the of the country’s opiate-related deaths since 1999.

Opioids are prescription pain relievers — such as OxyContin, methadone, hydrocodone, codeine, morphine — and heroin.

The Appalachian states include Kentucky, North Carolina, Ohio, Pennsylvania, Tennessee, Virginia and West Virginia. While these states have thriving urban and suburban communities, an Appalachian culture associated with people living close to the land, often associated with coal-mining communities, continues to persist along the Appalachian mountains.

asset_4_deaths_per_yearDrug overdose deaths are a nationwide problem. The death rate from drug overdoses has increased 137 percent since 2000. In 2014, more people died from drug overdoses in the United States than any other year on record, according the the Centers for Disease Control and Prevention.

Drug overdoses killed 47,055 people in 2014, and 61 percent of those deaths were opiate-related. The Appalachian region was especially hard hit. The seven states accounted for 22 percent of all opiate-related deaths.

The authors of a new report on the rising epidemic in Appalachia say poverty and a lack of higher education could be a factor.

According to the report, “the hardest-hit counties, where death rates have soared…have about half the national median household income while twice as many people live below the poverty level. College educations are dramatically lower than the national average in the most affected counties, and in a room full of 100 people about 40 won’t possess even a high school level education.”

“It’s pretty obvious that when you have a higher education level throughout a lot of these areas, that there’s more access to resources like places to go if you need help, drug resistance education, and things along those lines,” said Tristan Harris, project manager for the report from “Whereas, in an area where a much lower percentage of people are graduating from high school, much less from college, they [might not] have access to those kinds of programs or those resources.”

States’ attempts to crack down on prescription drug abuse over the past few years seem to be driving the move from prescription drugs to heroin.

“That’s the trend that’s been happening for the last few years,” Harris said. “It could be an issue with legislation coming across to help stem the over-prescribing of opioids, and it could be that people that have become addicted to those are turning to heroin when that supply is no longer available.”

North Carolina has managed to stem the tide. The state initiated a plan to combat opiated-related deaths in one of its hardest hit counties in 2008. By changing the way clinical professionals and residents were educated about and treated for opioid addiction, North Carolina was eventually able to reduce overall drug overdose deaths statewide.