Turns out that a single opioid crisis doesn’t actually exist. This year over 70,000 Americans have died in four distinct opioid epidemics, each bringing death through different drugs and regions.

Researchers at Iowa State University studied death certificates nationwide and found these four separate drug outbreaks:

The West and Midwest heroin epidemic: The overdose deaths cluster along interstates known to be smuggling routes for Mexican cartels. This epidemic is quite active in urban areas, and from El Paso to Denver, and in Texas through St. Louis into Chicago.
The rural Southern prescription epidemic: This is a continuation of the nationwide pharmaceutical overdose crisis that peaked in 2013 but continues in rural counties. The opioids mostly come from pharmacies, often prescribed to work-disabled former miners or manufacturing workers for their pain. Now that pharmaceuticals are more difficult to access, traffickers are creating counterfeit pills with prescription drugs such as OxyContin and hydrocodone mixed with easy-to-overdose-on synthetic opioids such as fentanyl.
The urban fentanyl epidemic: Street drugs such as heroin and cocaine are mixed with synthetic opioids and often made to look like prescription pills. This is ravaging Northeastern cities, as well as parts of Utah and New Mexico.
The unemployment opioid epidemic: Some unlucky counties are undergoing a “syndemic,” which means multiple epidemics at once, where people consume whatever drugs (prescriptions, heroin, synthetics) they can get their hands on. This is happening in regions where the opioid epidemic first blossomed in the 1990s and which have since undergone heavy job losses from mining and manufacturing in states including Kentucky, Ohio, and West Virginia.

Coauthor David Peters said in a statement that blanket policies aimed at stopping the “opioid crisis” will not work. “Better regulation of prescription opioids by states is going to have no impact on heroin deaths or synthetic deaths,” Peters says. Heroin epidemics are best approached by traditional law enforcement and targeted treatment, while the prescription epidemic is best addressed through poverty reduction and economic development.