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After nearly a decade when US drug overdose death rates were higher in rural parts of the country, drug death rates have shifted to be higher in urban areas, according to a new analysis from the US Centers for Disease Control and Prevention's National Center for Health Statistics.Researchers found that from 1999 through 2003, drug overdose death rates were higher in urban counties than in rural counties. Then, from 2004 through 2006, overdose mortality rates in rural and urban counties were similar. In 2007 through 2015, overdose mortality rates were higher in rural counties than in urban counties. But in 2016 and 2017, urban counties once again had higher rates of drug overdose fatalities.While urban counties had higher rates of overdose deaths involving heroin, cocaine and synthetic opioids such as fentanyl in 2017, rural counties had higher rates of overdose deaths involving prescription opioids such as morphine, codeine, hydrocodone and oxycodone.The overdose death rate related to stimulants such as methamphetamine and amphetamines was 4 per 100,000 in rural counties, higher than the rate of 3.1 per 100,000 in urban counties.In 2017, There were 5.2 heroin-related overdose deaths for every 100,000 people in urban counties, whereas rural counties had a rate of 2.9 heroin-related fatalities for every 100,000 people.In urban counties, the rate of overdose deaths from synthetic opioids such as fentanyl, fentanyl analogs and tramadol was 9.3 per 100,000; and in rural counties that rate was 7 per 100,000. Death rates involving cocaine were also higher in urban counties, with a rate of 4.6 per 100,000, compared to 2.4 per 100,000 in rural counties.But, Dr. Caleb Alexander, co-director of the Center for Drug Safety and Effectiveness at Johns Hopkins, said it was important to not make too much of the distinction between rural and urban areas. "It's important not to lose the forest from the trees here," he wrote in an email to CNN. "Overall the trends and rates are much more similar than they are different between these communities."Alexander noted that the increased overdose rate in urban areas "is attributable to the greater use of heroin and illicit fentanyl in these settings.""The data demonstrate continued increases in mortality through 2017, and they underscore that the epidemic has had a profound impact in rural and urban areas alike," he added.Drug overdose deaths in the United States declined 5.1% in 2018, according to preliminary data released in July by the US Centers for Disease Control and Prevention's National Center for Health Statistics. Researchers estimate there were 68,557 drug overdose deaths in 2018, and 47,590 involved opioids. 2702

A pilot was pulled from the Hudson River after a helicopter crashed in the water near where the Lincoln Tunnel comes into Manhattan, authorities said.The pilot was the only person aboard the helicopter and was rescued by the New York Police Department's Aviation and Harbor unit, according to a law enforcement official with knowledge of the rescue.The pilot is expected to be OK, the source added.Video of the crash, recorded by Ashton Byrd, shows the aircraft descending toward the water with its nose down and its rotors moving. The helicopter appears to level out and water sprays as the craft goes down.The-CNN-Wire? & ? 2019 Cable News Network, Inc., a Time Warner Company. All rights reserved. 716

AHMEDABAD, INDIA — President Donald Trump has opened a whirlwind 36-hour visit to India by basking in the adulation of a massive, colorful crowd at a cricket stadium in the western city of Ahmedabad. Trump and Indian Prime Minister Narendra Modi lavished praised on each other during back-to-back speeches to thousands of revelers packed into the stadium in 80-degree heat. It was the biggest rally crowd of Trump's political career. Trump's visit is meant to reaffirm U.S.-India ties strained by trade disputes. But it's also providing enviable overseas imagery for a president in re-election mode. 613

A Missouri judge issued an order Monday to keep a preliminary injunction in place allowing Planned Parenthood to continue performing abortions at its St. Louis clinic until 5 p.m. Friday, according to a statement from 230

Alaska Airlines is dropping its sponsorship of the Iditarod Trail Sled Dog Race after this year's race. The company says in a statement that it has been part of the Iditarod for over 40 years but the company is transitioning to a new corporate giving strategy. The race's biggest critic is People for the Ethical Treatment of Animals and the group praised the airline's decision. PETA has pressured race sponsors and held protests outside Alaska Airlines' Seattle corporate offices. Alaska Airlines says PETA did not play a role in its decision. This year's Iditarod has its ceremonial start Saturday in Anchorage, with the competitive start the next day. 668