It’s no great revelation to note that as the face of drug use in America has shifted from Black and urban to white and rural, so has the nation’s attitudes about addiction, treatment, and empathy for those who abuse narcotics.

But as Dr. Jerel Ezell, a social epidemiologist and assistant professor at Weill Cornell Medicine, explains in a new piece for TIME, rural drug use is not confined to whites—rural Black addiction is rising, while presenting specific and unique challenges. As he points out:

• The steepest increase in overdoses in recent years has been among younger urban Black Americans (178%), followed by younger rural Black Americans (98%), and younger urban white Americans (93%).
• Rural Black people have the highest poverty rates among rural residents, at 30% vs. 12% poverty among rural whites. Rural Black people also have higher rates of mental illness, cardiovascular disease, cancer diagnosis, and sexually transmitted infections.
• Drug use is driven by limited socialization and recreation opportunities for Blacks in rural areas, and a predominance of physically-intensive jobs in farming, manufacturing, construction, and mining, where workplace discrimination and social isolation are high.