The opioid crisis is the story of many kinds of pain. What tends to dominate that story is an awful paradox: fifteen to twenty years ago, well-meaning efforts to kill pain began to kill people instead.

But while the death toll is unquestionably horrifying, this crisis extends well beyond addiction.

It’s also causing huge collateral damage among people in every walk of life who are not addicted. It is creating community-wide aftershocks in child welfare, elder abuse, public safety, criminal justice, the workforce, the economy, caregiving, housing, and, of course, health care. It is ravaging rural America and menacing millions of older people.  

This is a wake-up call for all of us, inside and outside of philanthropy, to look beyond addiction and respond to all the aftershocks of the opioid epidemic.

Widening the Lens: the Impact on Rural Communities and Older People

Small towns and rural places are feeling some of the worst impact.

Rural communities tend to be self-reliant, and also older than the rest of the country. Their resources can be limited and they are frequently overlooked. This is a dangerous mix: according to the CDC, people in rural counties are nearly twice as likely to overdose on prescription painkillers as people in cities. The resulting community chaos, personal pain, and economic loss are enormous as well.

A key strength of rural communities – cohesiveness – can actually make matters worse, particularly for older people who are drawn into the troubles of addicted children, friends, and extended family. Many are desperately trying to keep a struggling family member afloat, and the growing number of grandparents raising the children of addicted parents in “grandfamilies” has paralleled the growth of the epidemic.

These gestures of love are not without risk. An older adult living in public housing who tries to shelter an addicted child or grandchild risks eviction under anti-drug use regulations from the Department of Housing and Urban Development. A rise in elder abuse and financial exploitation is also attributed to the opioid crisis, as more adult children with addiction problems move back in with their parents.

Other problems include widespread chronic pain, which patients and geriatricians worry will go untreated as access to opioids is curtailed while alternative treatments remain hard to find, and the lack of age-appropriate treatment options for late-life chemical dependency.

A Blind Spot for Funders

Another stark reality is that philanthropic attention for rural America has historically been disproportionately low. This neglect has been costly for a huge part of the country that is crucial to agriculture, manufacturing, energy, and more. As former Agriculture Secretary Tom Vilsack has said to the philanthropic community about rural America, “Folks, this is an important place, and it needs to be treated as such.”

This is why the organization I lead, Grantmakers In Aging (GIA), has launched a three-year initiative, supported by Margaret A. Cargill Philanthropies, to encourage all types of funders to increase their involvement with rural America. Those interested can learn more at

A Closer Look: Resources for Philanthropy

This multi-faceted crisis presents numerous entry points for philanthropies of all types and sizes. What’s important now is for funders to begin to help overwhelmed communities figure out what they need and where to start. 

A new guide from GIA, Heartache, Pain, and Hope: Rural Communities, Older People, and the Opioid Crisis: An Introduction for Funders, offers information on many existing grant-funded programs and initiatives, such as:

Taking a wide-angle view of the opioid crisis is the only way funders and our partners can hope to have a meaningful impact and help millions of individuals and communities in pain.