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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

Actor Cuba Gooding Jr.'s sex abuse trial is set to begin Tuesday with jury selection in New York City.Gooding is charged with forcible touching, a misdemeanor, and sex abuse in the third degree related to an alleged groping incident in June.A 29-year-old woman filed a police report claiming Gooding grabbed her breast at Magic Hour Rooftop Bar & Lounge in Manhattan.Gooding has denied the claim.The actor voluntarily surrendered to New York police for questioning in June and was released on his own recognizance.The woman in the alleged incident told police she was with friends when she was confronted by a male patron whom she described as Gooding, a law enforcement source told CNN."The male allegedly groped her breasts," the source said. "The victim later told cops she protested at the unwanted touching and they argued about the encounter."The woman left the bar and called 911 to report the alleged incident, the law enforcement source said, and NYPD Manhattan Special Victims Squad investigated.Gooding's attorney has said video footage taken at the bar that night will clear his client."There is not a scintilla of criminal culpability that can be attributed to Mr. Cuba Gooding Jr. after I have extensively, with my staff, reviewed the video of almost two hours which reflects the entire event," Mark Heller told reporters in June."I am totally confident that when a jury of Cuba Gooding Jr.'s peers assess all of the exculpatory evidence in this case, that he will be totally exonerated," Heller added last month. 1543

A Virginia doctor was gunned down with his tour guide while on vacation in Belize, according to local authorities.Gary Swank was visiting the Central American country with his family. He had been on a fishing boat with local guide Mario Graniel when they were both shot dead, Belize Police Commissioner Chester Williams said in a press conference Monday recorded by the San Pedro Sun newspaper.In the recording, Williams said the tour guide had a disagreement with a local gang kingpin, and agrees that Swank was a "victim of circumstance."Graniel had earlier reported to police that someone fired shots at his home on Friday, but he never filed a formal complaint, Williams said."We maintain police presence in the area to protect him and the community from further shootings but we can't follow the man everywhere he goes," he said. "He decided to go out with a tourist.""We did what we could have done in terms of detaining those who we believe were responsible and maintaining presence in the area where he lived."CNN has reached out to Belize authorities, but has not heard back.Swank was 'a well-respected and well-loved colleague'Swank was the medical director of Carilion Clinic cardiac catheterization lab and an associate professor of internal medicine at the Virginia Tech Carilion School of Medicine, according to a statement from the clinic. The school is in Roanoke, Virginia, about 170 miles west of Richmond."Dr. Swank was a well-respected and well-loved colleague who, each and every day, embodied the values that we hold dear," the statement reads. "His absence leaves a void in our team and in our community."Swank's patients were devastated to hear of his death."He saved my life, and every time I went to his office he was a very knowledgeable, patient and caring person," Teresa Hodges, who was Swank's patient for 13 years, told 1864

A manhunt is on for a gunman who opened fire at an off-campus homecoming party near Greenville, Texas, killing two people and sending 14 more to area hospitals, police said Sunday.The party may involve a Texas A&M University-Commerce fraternity, though the event was not sanctioned by the school, Chief Deputy Buddy Oxford of the Hunt County Sheriff's Office said.Gunshots rang out about 11:45 p.m. (12:45 a.m. ET) Saturday at The Party Venue, an event space located on a sparsely populated stretch of Highway 380. Greenville is a city of 27,000 located 50 miles northeast of Dallas.Authorities first responded to complaints of vehicles parked along the highway, Oxford said, and the shooting began about 15 minutes after they arrived.Investigators have yet to establish a motive but are looking for a single shooter, the chief deputy said.There were about 750 people at the venue when police arrived, Oxford said.The FBI and Texas Rangers are assisting in the investigation, he said."Our thoughts and prayers are with the victims, families, and friends of those affected by this morning's shooting in Greenville," Texas A&M University-Commerce said in a statement.The university and its police department are working with the sheriff's office to determine whether any of the victims are students, the statement says.Earlier, the school's police department 1376

A Texas stepfather spotted the boy who allegedly bullied his daughter while walking home from school. What he did landed him in jail. James Olander Peace is charged with felony injury to a child for slapping a 12-year-old boy across the face.Peace's wife spoke with KTRK-TV by phone, saying her husband was sticking up for her daughter after she was bullied by a 12-year-old boy and his friend while walking home from school."Saying that her body was ugly...started throwing ice cream at her and then they picked up the rocks," said the girl's mother. She says her daughter called and asked for a ride home. 619

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