Rates of Drug Use: Urban, Suburban, & Rural

Article Overview:

New Jersey is widely known for its population density. The fourth smallest state in the country is also the eleventh most populous, with over 1,200 people per square mile, and it is one of the most ethnically diverse states in the country. Amidst that throng of people, one shared problem has given the state an unwanted identity: rates of drug use across urban, suburban, and rural New Jersey are among the highest in the nation, making the Garden State a microcosm of America’s biggest public health crisis.

Rates of substance abuse in Rural areas,Urban, and Suburban

The Hidden Cities of New Jersey

Apocalypse and Herointown is the sign of how widespread the drug problem in tightly packed New JerseyThere are two places in New Jersey that won’t show up on official maps, but everyone knows exists: Apocalypse and Herointown. Their hypothetical existence is a sign of how widespread the drug problem in tightly packed New Jersey has become. It has transcended racial and socioeconomic demographics, sweeping through gutted inner cities and suburban neighborhoods with neatly trimmed lawns. It is a result of pharmaceutical companies pumping hundreds of millions of dollars into highly addictive medications, post-industrial decline causing staggering levels of poverty and corruption, and organized crime making the most of the state’s strategic access to the markets of New York, Baltimore, and Philadelphia.

NJ.com writes that if Herointown were an actual city, it would be the fourth largest city in New Jersey.1 Its entire population of 128,000 people would be made up of the 49 percent of New Jersey residents who received treatment for heroin and prescription medication abuse. Most of Herointown’s residents have access to a steady stream of drugs like OxyContin and Vicodin, liberally prescribed by doctors who receive big bonuses from the pharmaceutical manufacturers of those drugs. The Monmouth County prosecutor blames the avalanche of pills for flooding communities of all sizes across the state and the country with legal, powerful, and potentially deadly drugs.
People in Herointown invloved with drug abuse by prescribed painkillers or medications

In Herointown, no one starts out as a drug addict. Its residents are prescribed painkillers for legitimate medical reasons, such as for chronic pain, or workplace or sports injuries. But even at regular doses, a drug like OxyContin – which PBS writes is one of the most abused prescription drugs in the country – can be habit-forming.2,3

In the fourth largest city in the most tightly populated state in the country, everybody seemingly knows everybody. Residents don’t think twice about letting a friend or a neighbor have some of their OxyContin pills, reasoning that since the drugs came from a doctor’s office, and they were purchased quite legally, there can’t be anything inherently harmful in sharing. Stories spread from one neighborhood to another of how good the OxyContin makes you feel – how it not only makes your pain go away, but how you also feel so relaxed, so calm, and so peaceful after taking a pill.

Without realizing it, the people of Herointown begin taking more OxyContin. They fake injuries, forge prescriptions, and go to multiple doctors to get more pills. Somebody gets a large haul of OxyContin and begins selling it out of their home. Life begins to revolve around getting more OxyContin and being on OxyContin, and the well-educated and highly paid citizens of Herointown – lawyers, politicians, and even teachers and scientists – become more preoccupied with the sweet narcotic bliss of their drugs than they do their families, their jobs, and their futures.

Eventually, word spreads that there’s a cheaper alternative to OxyContin. No one in New Jersey’s fourth largest city started out being a drug addict, but when they hear that heroin – derived from the same chemical compounds as the oxycodone in OxyContin – costs less than a McDonald’s meal, they fall prey to what NJ.com calls an “economically sound alternative.”

New Jersey’s Dirty Secret

Heroin is the dirty secret of New Jersey’s suburbs, writes North Jersey News.The problem is fueled by doctors receiving enormous financial incentives to push pharmaceutical products to their patients. News12 found that doctors across New Jersey were paid more than $50 million by drug-manufacturing companies in 2015 to promote or otherwise endorse brand-name drugs. There is nothing illegal about the practice, but medical ethics advocates worry that doctors may be choosing to prescribe drugs to patients based on what they (the doctors) get out of the deal.5 The result is that doctors in New Jersey prescribe more brand-name drugs than doctors in any other state in the country.6 The national average of patients receiving brand-name prescription medication (compared to generic drugs) is 21.2 percent; in New Jersey, however, that rate shoots up to 28 percent.

For residents across New Jersey, why is this significant? For consumers, the question is one of cost. Brand-name drugs, still under patent protection by the manufacturer, lean towards being priced much higher than their generic counterparts.7 With the pharmaceutical industry having very deep roots in New Jersey, affluent consumers – most of whom reside in the suburbs – may think nothing of shelling out more and more money to ensure that their prescriptions of narcotics never run out.

Doctors were paid more than $50 million by drug manufacturing companies in 2015 to promote brand-name drugs.

The Nation’s Medicine Cabinet

New Jersey was known as the nation's medicine cabinet for pharmaceutical research, production and distributionNew Jersey was once the center for pharmaceutical research, production and distribution, writes The New York Times, so much so that it was known as “the nation’s medicine cabinet.”NPR explains that such companies were drawn to the Garden State’s quality of life, and its proximity to big population and business centers in New York, Philadelphia, and Baltimore made it “the heartland for pharma.” In 1990, there were almost 42,000 pharmaceutical jobs in New Jersey, drawn by supportive government programs, a choice of financial markets, and billions of dollars in venture capital. And, says the president of a biotech trade group, “New Jersey is a great place to live.”9

One of those companies is Endo Pharmaceuticals, which has an office in downtown Newark. Endo Pharmaceuticals is the producer of Opana, a potent opioid-based painkiller containing oxymorphone. NPR reports of how patients would crush Opana tablets and snort them, delivering what should be a timed 12-hour release in one single intake. Others would dissolve crushed Opana pills in water and inject them intravenously.10 Before Endo Pharmaceuticals reformulated their product to make it less appealing for recreational use, Opana was quickly distributed on the black market to addicts in rural, suburban, and urban areas, both in New Jersey and across the country.

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New Jersey’s Plague

Speaking to NJ.com, the chairman of a task force put together by the New Jersey government on heroin and opiate abuse said that the “significant diversion of prescription drugs” (a medical and legal term used to describe the transfer of a legally prescribed medication from the person for whom it was originally prescribed to another person who has no prescription, to use for illicit purposes, such as recreation) has increased the number of heroin users across New Jersey.11 Much like the fictional residents of Herointown, many people in New Jersey’s suburbs and communities wouldn’t dream of becoming heroin addicts, but they think nothing of taking some extra pills given to them by their doctor, and sharing them with friends and family who can’t get prescription of their own. By the time their habit takes them to heroin, they are too desperate and hooked to care.

Such a practice may fall along race-related lines. A law professor at the University of Minnesota told PolitiFact that white Americans tend to sell drugs to people they know, and they tend to sell drugs privately. Black Americans, on the other hand, usually sell drugs to strangers, and in public, which leads to greater (and misleading) perceptions that drug crime and punishment are more problems for black communities than they are for white communities.12

Heroin offered in New Jersey peaks at 58% purity – Compare that to neighboring New England at 14%

“A heroin epidemic is plaguing New Jersey,” writes ViceNews, explaining how drug dealers working out of the key import point of the Port Newark-Elizabeth Marine Terminal provide an unending supply of chemically pure heroin – the purest heroin to be found in the United States – to medication-hooked consumers in New Jersey’s suburbs.14 Organized crime rings from South America look at cities like Baltimore (“the heroin capital” of the United States) and target New Jersey’s busy ports system as a way of getting their product into the country.15 The heroin that arrives in New Jersey is untainted by other products.16 In neighboring New England, the average purity level of heroin is 14 percent. The Drug Enforcement Administration warns that the fresh heroin on offer in New Jersey peaks at 58 percent chemical purity but still remains insidiously available and accessible, in the words of the Hunterdon County Prosecutor’s Office.17,18

A Perfect Storm of Drug Use

Just about a hundred miles south of the Port Newark-Elizabeth Marine Terminal, and only 25 miles away from Philadelphia, is Williamstown, in the Monroe Township of Gloucester County, where the 2014 heroin death rate (63.8 deaths per 100,000 people) was a quarter that of the national average.19 The New Jersey Department of Health found that in Gloucester County itself, the heroin death rate of 17.3 fatalities per 100,000 people in 2014 was almost seven times the national average. Three other New Jersey counties – Atlantic, Camden, and Cape May – had higher death rates.

The ease of access and a combination of middle-class teenagers in a tightly-knit community, who have almost unrestricted access to powerful prescription drugs, create a perfect storm for drug use to spread across New Jersey’s suburbs.

Unrelenting and Rampant

People died due to heroin and prescription medication overdosesJust south of the New Jersey Turnpike, Washington Township (population 50,000) lost 23 of its residents due to heroin and prescription medication overdoses in the decade between 2004 and 2014. West of the Atlantic City Expressway is Glassboro (population 20,000), the borough lost 11 of its residents in that same time period. Deptford, off Highway 55, buried 18 of the 30,000 who call it home; and Newfield, with fewer than 20,000 people, recorded four deaths by overdose.

In Williamstown, an unincorporated community and census designated place of 15,567 people, the student assistance counselor at Williamstown High School tells NJ.com that alcohol and marijuana are no longer the problem. The problem is that the school at which she works has come to be known as “Pilliamstown High.”

“Unrelenting Drug Abuse Now Running Rampant in Rural Areas,” blasts a headline on NJ.com.20 The scourge is not a recent one; as far back as 2001, the director of research in the division of addiction services of the New Jersey Department of Health told WebMD that an uptick of heroin use among people aged 18-25 was making its way into the suburbs and rural areas of the Garden State.21

The City of Apocalypse

Washington and Gloucester Townships feel the brunt of the heroin trade that snakes its way through Philadelphia, but one of the places in the Garden State that has it worse is the city Rolling Stone magazine called “Apocalypse.”22 Camden, New Jersey is just across the Delaware River from Philadelphia, and the drug trade in the city is endlessly maintained by young, white people from neighboring suburbs. Rolling Stoneestimates that 85 percent of the city’s heroin customers fit that description; but like in Herointown, they don’t start with heroin. They strain a muscle playing sports or get in a car accident, and are then prescribed OxyContin. It takes them a few years to drift out of their homes and jobs, and come to Camden, where 80-90 percent of the drug-related arrests involve people from the suburbs.

80-90% of the drug-related arrests involve people from the suburbs

Such is the extent of the problem that SJ Magazine tells its readers that “[they] might think drug addicts live only in Camden.”23 Some of the customers come because of all the press and publicity Camden has received for the purity of the heroin being sold. The high number of resultant deaths makes the bait seem all the brighter.

Camden wasn’t always like this. In the early 20th century, it was a booming city of business and industry, but the jobs moved out of the state and left a gaping social void in their wake. In the inferno of frustration and desolation, racial tensions and crime moved in. Rolling Stone writes that Camden sees $250 million in drug sales move through the city every day, even as the total municipal tax revenue was only $24 million in 2011.

The problem ran so deep that the state of New Jersey had to pay for Camden’s police force, until Governor Chris Christie announced that “the taxpayers of New Jersey” would no longer be responsible for Camden’s problems. He cut municipal state aid by $445 million, a move that pushed the police “into almost total retreat.” Deprived of manpower and motivation, law enforcement focused their efforts on gun crimes committed during daylight hours, leaving drug dealers to sell their products in broad daylight, sometimes giving interviews to local news outlets as they did so. 

Heroin bags costing as $4 in the city of Camden

It took some time for the government to fight back, pumping money into new and improved police programs, but progress has been slow and excruciating. Camden is still “full of white kids on dope,” a gang member told Rolling Stone, a marked change from when the city’s population was 53.35 percent African American.

The Nation tells a similar story about Camden, the poorest city in the United States (ranked per capita) and the most dangerous. The misery breeds, and is bred by, “a hundred open-air drug markets” run by various gangs selling to desperate clients who make the drive in from the surrounding suburbs. The sale of bags of heroin, costing as little as $4, is one of the only thriving businesses left in the city of Camden – the “poster child of post-industrial decay”.24

More than the Flu and Pneumonia

Across the Garden State’s townships and communities, more people lose their lives to heroin than to homicide, car accidents, HIV-AIDS, or suicide.25 In Camden and Atlantic Counties, statistics from the Department of Health revealed that heroin kills more people than the flu or pneumonia, combined.26

When Hurricane Sandy devastated New Jersey in 2012, there were at least 37 confirmed fatalities. The New Jersey assistant state medical examiner found that between 2011 and 2012, prescription painkiller overdoses killed more than 700 Jersey residents.27 In 2013, the First Assistant Attorney General stated that 40 people in New Jersey die every day because of overdoses. In Sussex County alone, with a population of 143,673, 12 of its residents overdosed on heroin, their prescription medication, or both.28

In the words of a report issued by the Governor’s Council on Alcoholism and Drug Abuse, the use of heroin and opioids is “skyrocketing” to the point where it is the primary public health crisis facing New Jersey. In two years, from 2010 to 2012, deaths related to drug abuse have increased by 53 percent; over 66 percent of those deaths came from overdosing on prescription painkillers.29

The death rate of prescription painkiller overdoses in NJ is 3X higher than the national average; in certain parts of the state, it is 7X higher

Perhaps most ominously for the authorities in New Jersey, the danger doesn’t come from shadowy alleys in crowded inner cities, although the problem certainly exists there. The danger originates from a trusted doctor’s office, or an unlocked medicine cabinet at home or at school. It has infested New Jersey’s packed urban areas, but has also bled into tightly knit neighborhoods and bucolic farms – a wave of heartache and death that starts with a pill from a pharmacy, becomes a $5 bag of heroin, and ends all too frequently in death.

Research Articles


  1. Welcome to Herointown, New Jersey’s 4th Largest City.” (n.d.). NJ.com. Accessed July 13, 2016
  2. “Which Prescription Drugs Do Americans Abuse Most?” (April 2013). PBS Newshour. Accessed July 13, 2016.
  3. “OxyContin.” (n.d). Drugs.com. Accessed July 13, 2016.
  4. Heroin: Suburbia’s Deadly Secret.” (April 2015). North Jersey News. Accessed July 13, 2016.
  5. “Kane in Your Corner: NJ Doctors Got $50M from Drug Companies.” (July 2015). News12. Accessed July 13, 2016.
  6. “New Jersey Tops Country in Prescribing Brand-Name Drugs.” (November 2013). NJ Spotlight. Accessed July 13, 2016.
  7. What’s the Difference Between Brand-Name and Generic Prescription Drugs?” (December 2004). Scientific American. Accessed July 14, 2016.
  8. Smaller Firms Gain Foothold as Big Drug Makers Shrink.” (May 2009). The New York Times. Accessed July 13, 2016.
  9. As Pharma Jobs Leave N.J., Office Space Ghost Towns Remain.” (July 2014). NPRAccessed July 13, 2016.
  10. How a Painkiller Designed to Deter Abuse Helped Spark an HIV Outbreak.” (April 2016). NPR. Accessed July 15, 2016.
  11. “New Jersey’s Heroin Crisis: State Report Calls For Major Reforms.” (March 2014). NJ.comAccessed July 14, 2016.
  12. “Van Jones Claim On Drug Use, Imprisonment Rates For Blacks, Whites Is Mostly Accurate.” (July 2013). PolitiFact. Accessed July 14, 2016.
  13. The Great American Relapse.” (November 2014). The Economist. Accessed July 16, 2016.
  14. A Heroin Epidemic is Plaguing New Jersey.” (April 2014). Vice News. Accessed July 14, 2016.
  15. “National Geographic Depicts Baltimore As ‘Heroin Capital Of America’.” (August 2014). The Baltimore Sun. Accessed July 14, 2016.
  16. “National Geographic Depicts Baltimore As ‘Heroin Capital Of America’.” (August 2014). The Baltimore Sun. Accessed July 14, 2016.
  17. DEA Warns of High Purity Heroin in N.J.” (September 2014). NJ.com. Accessed July 14, 2016.
  18. “Heroin’s Purity, Price Fuel Abuse, Say Hunterdon Officials.” (September 2015). NJ.com. Accessed July 14, 2016.
  19. “Inside The N.J. Town With A Heroin Death-Rate 25 Times The National Average.” (January 2016). NJ.com. Accessed July 14, 2016.
  20. “Unrelenting Drug Abuse Now Running Rampant in Rural Areas causing OD’s and Death.” (April 2015). NJ.com. Accessed July 15, 2016.
  21. “Heroin Use Higher in New Jersey’s Suburbs, Rural Areas.” (May 2001). WebMD. Accessed July 15, 2016.
  22. “Apocalypse, New Jersey: A Dispatch From America’s Most Desperate Town.” (December 2013). Rolling Stone. Accessed July 14, 2016.
  23. Heroin in the Suburbs.” (n.d.) SJ Magazine. Accessed July 14, 2016.
  24. City of Ruins.” (November 2010). The Nation. Accessed July 15, 2016.
  25. “N.J. Heroin-Related Death Rate Among Worst In The Country | Your Questions Answered.” (July 2015). NJ.comAccessed July 15, 2016.
  26. “N.J. Heroin Overdose Death Rate Is Triple The Soaring U.S. Rate.” (July 2015). NJ.comAccessed July 15, 2016.
  27. “N.J. Heroin, Painkiller Use Growing, Experts Warn.” (September 2013). NorthJersey.com. Accessed July 15, 2016.
  28. “Doctors Hear Of Horrors Of Epidemic Of Prescription-Drug Addiction.” (October 2013). NJ Spotlight. Accessed July 15, 2016.
  29. “Confronting New Jersey’s New Drug Problem: A Strategic Action Plan To Address A Burgeoning Heroin/Opiate Epidemic Among Adolescents And Young Adults.” (2014). Governor’s Council on Alcoholism and Drug Abuse. Accessed July 15, 2016.
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