I've lived in small towns and big towns. The difference is that in the big town the drug users are anonymous in that you don't know them. In the small down they are your coworker's sister's brother in law.

I lived in a town of 20k people that was BY FAR the largest for an hour drive in any direction. Lots of drunks. First place I lived there, my neighbor was selling meth, put up a confederate flag in their window when a black lady moved into my duplex, and was shot 6 times later than year (survived, since we was shot by a shaky meth head who used a 22). They were banned from the place and police wouldn't do shit whenever they were back and they got mad at me when I demanded they take care of the screaming meth head at 6am on a Saturday. They stole parts off my truck. There were meth heads climbing their fence all hours and days. I literally watched a different neighbor get arrested by a cop who said "hey, don't we have a warrant for you?" (neo nazi guy, who just turned around and the cuffed him). When I moved later that year? Heard nothing. Wouldn't have known. Only thing was you'd still see grown men riding children's bikes because you know they lost their license. No one rode bikes there. Shit was dangerous as hell.

I went to college in a non-college town about twice that size (college was <2k people), and again, lots of drunks. Different sides of the country but both were very Christian and even had strict drinking laws. The uni didn't allow alcohol so a lot of kids were just drinking and driving (closest bar was a mile away and downtown was a 15 minute drive).

Look at a heat map of opioid deaths. Then tell me again how this is a problem exclusive to big cities. If it wasn't in small cities, you wouldn't see a looming crisis in The Blue Ridge. If it were shame, Utah wouldn't be an epicenter.

The thing is that humans are really fucking bad at statistics. We internalize them by total samples of the event, unnormalized. Which is already an incredibly biased lens. I guarantee you that several people in your town were doing drugs, you just didn't know. Just take a minute and ask your self "do I know what I'm talking about or did I just pull this outta my ass?" We need a lot more of that if we're being honest.