Indeed, and to make it even more of a mess, regional issues also correlated with economic issues. My unorthodox opinion is that the opioid crisis started with an actual pain crisis due to the kinds of jobs that people were working, coupled with a lack of strong labor law enforcement and safety net. People were turning to pills because they were in pain.

It seems like religious people would be far less likely to seek professional help for abuse and that would skew these numbers greatly, considering the methodology.

Religious community members have far more reason to avoid acknowledging their drug problem in a way that might make that information public.

Surely that is circular - if religion did cause less drug addiction (and/or dealing) then you'd expect less distribution and thus availability in religious areas because there's less demand.