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Notes -
This is certainly a big narrative point but it doesn't match my experience with boots on the ground seeing patients (which isn't to say it's incorrect, the data is out there, but I want to call out other factors).
Keep in mind that America has additional problems that do not exist elsewhere: our particular brand of inner city life and crime seems to generate a lot of drug addictions (you'd be shocked at how many bangers are also addicts, or maybe not), a lot of the use in the US persists in inner cities that refuse to attempt to solve the problem or economically depressed areas in coal country and so on that don't really exist in the rest of the west I think.
Also research shows that Americans are weirdly pain intolerant in comparison to other countries.
I'd guess that such rust belts are a staple in most First World countries. And I'd be surprised to learn that the US is overall more lenient towards drug crime than other Western countries.
I think what make's the US rust belt different is that it's so large because the country is so damn huge (maybe kinda like Russia in that way?). Canada and Australia are also enormous but much more population focused.
I don't think other countries have something like Kensington in Philadelphia, although I've heard political winds have changed and theirs some thought the situation will be improved soon.
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