Nebraska experienced relatively low rates of drug overdoses compared with other states until 2017-18, when the overdose rate jumped 48 percent.
And as the rate of deaths related to drug overdoses largely attributable to opioid addictions has plateaued nationally, Nebraska is now catching up.
Complicating matters is the fact that drug users in Nebraska, like those across other Midwestern states, are more likely to be addicted to a combination of substances, a phenomenon that has been largely understudied and presents challenges to developing strategies for prevention and treatment.
A new research center at the University of Nebraska-Lincoln will take a deep dive into understanding the causes and effects of drug addiction in rural areas through a five-year, $11.8 million grant from the National Institutes of Health's Centers of Biomedical Research Excellence.
The Rural Drug Addiction Research Center, or RDAR for short, will seek to study addiction from "synapse to society" in the Midwest, according to center director Kirk Dombrowski, a UNL professor of sociology.
"Until the most recent overdose spate, no one was looking at rural drug use in general," Dombrowski said during a phone interview Wednesday.
The center, the first of its kind in the region and fifth NIH Center for Biomedical Research Excellence at UNL, will continue research into the neuroscience behind addictions to multiple drugs, the cognitive implications of long-term drug use, and the social relationships between drug use and violence.
At the core of the new center is a long-term study of 600 rural drug users across Southeast Nebraska, Iowa, Kansas and Missouri using research methods previously deployed in Appalachia and rural Puerto Rico, Dombrowski said.
Later this year, the Rural Drug Addiction Research Center will recruit a small number of anonymous "seeds," or initial research participants, who will be compensated for referring other drug addicts into the study.
"It hasn't been done in the Midwest, but we're confident we can get it to work," Dombrowski said.
One of the early theories explaining why Midwestern drug users became addicted to multiple drugs noted that because some substances were less available in rural areas, those individuals took advantage of whatever they could get their hands on.
Later research, however, showed access to drugs was relatively the same across urban and rural environments, Dombrowski said, meaning the abuse had nothing to do with supply or variability.
Much of the thinking now is centered on the sociological concept of "homophily," the notion that individuals will seek out others with similar interests -- or, more simply put, "birds of a feather flock together."
"Once a habit of polysubstance addiction does get established, new users tend to take on the habits of those already in the community," Dombrowski said.
Midwestern drug users don't have drug dealers so much as they have co-users, he added, which is "why the peer referral system will work."
Subjects who join the study will be given cellphone software developed by UNL which uses GPS and artificial intelligence to track users and tailor survey questions narrowly to their experience based upon their replies and location.
Dombrowski said the long-term study may help researchers better understand why Midwestern drug users have addictions to multiple substances, and in conjunction with the University of Nebraska Medical Center will transform understanding into education resources for local practitioners, service organizations and policymakers.
Along with addressing the problems of rural drug addiction, the Rural Drug Addiction Research Center will also seek "to bring along whole generations of researchers in this area," Dombrowski explained.
UNL will seek to give research opportunities to early career faculty, postdoctoral researchers and graduate students in fields such as psychology, sociology, anthropology, computer science and biology to produce a larger body of knowledge.
They'll share their own research and learn from other national experts this fall at the first National Rural Addiction Research Symposium.
Chancellor Ronnie Green said UNL was "uniquely positioned to lead the way in improving the health and well-being of so many in the Midwest and beyond" by attracting world-leading faculty to the research center.
Dombrowski said the center will seek to answer the biggest question surrounding the rising rates of drug use and overdoses in Nebraska and elsewhere.
"These days, with so many people dying, the question of 'why' becomes much more prominent," he said.